Advances in pancreas surgery: robotic pancreaticoduodenectomy

Abstract

Surgeon technical improvements made in the 1980s significantly decreased the morbidity and mortality associated with pancreaticoduodenectomy (PD). While minimally invasive surgery (MIS) is now the standard surgical approach for many benign and malignant pathologies, the technical complexity associated with PD presents many challenges to MIS adoption. However, advancements in robotic technology have done much to ameliorate mechanical impediments. Compared to laparoscopic surgery, the robotic platform provides surgeons with enhanced visualization, greater degrees of freedom and range of motion, tremor elimination, and superior ergonomic positioning. Although cost and availability concerns persist, training programs have increasingly incorporated robotic curricula, boosting the prevalence of robotic procedures, including robotic PD (RPD). While prospective data are limited, studies evaluating RPD demonstrate safety, equivalent short-term oncological outcomes, and longer operating times compared to open PD. Furthermore, exciting avenues exist for the future of RPD, ranging from continued instrument innovations to AI-enhanced adjuncts. Robotics has the potential to improve PD for patients and surgeons alike; however, further evaluation of oncologic and surgical outcomes requires well-powered, randomized, prospective trials to confirm the results of earlier retrospective studies, given the significant biases present. In this article, we review the progression of minimally invasive PD, present outcomes from studies evaluating RPD, and discuss areas of innovation for RPD.