Comparison of Reduced-Port Totally Robotic Pancreaticoduodenectomy with Conventional Totally Robotic and Laparoscopic Pancreaticoduodenectomy

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Robotic Surgery

Background:

• Limitations in assistant mobility and visualization exist with conventional robotic pancreaticoduodenectomy (cRPD).
• Reduced-port totally robotic pancreaticoduodenectomy (rpRPD) was developed to overcome these challenges.
• Evaluating rpRPD's feasibility and consistency against cRPD and laparoscopic pancreaticoduodenectomy (LPD) is crucial.

Purpose of the Study:

• To compare the clinical feasibility and procedural consistency of rpRPD.
• To assess perioperative and oncologic outcomes of rpRPD versus cRPD and LPD.

Main Methods:

• A retrospective cohort study included 40 rpRPD, 60 cRPD, and 262 LPD patients (Jan 2015 - Dec 2024).
• Clinical outcomes and learning curves were analyzed using regression and CUSUM analysis.
• Lymph node retrieval was assessed for oncological equivalence.

Main Results:

• rpRPD demonstrated significantly shorter operative times and lower blood loss compared to cRPD (p < 0.001, p < 0.05).
• Postoperative complications and hospital stay were similar across groups.
• Learning curve analysis indicated lower variance and more stable performance for rpRPD than cRPD.
• Comparable lymph node retrieval supported oncological equivalence.

Conclusions:

• rpRPD offers comparable perioperative and oncologic outcomes to cRPD and LPD.
• This technique enhances operative efficiency and procedural predictability in minimally invasive pancreatic surgery.
• rpRPD is a technically feasible and safe alternative for pancreaticoduodenectomy.