Laparoscopic and robotic distal pancreatectomy: The choice and the future

Introduction: Distal pancreatectomy (DP) is currently well established as a minimally invasive surgery (MIS) procedure, using either a laparoscopic (LDP) or robotic (RDP) approach. Methods: Out of 83 DP performed between January 2018 and March 2022, 57 cases (68.7%) were performed using MIS: 35 LDP and 22 RDP (da Vinci Xi). We have assessed the experience with the 2 techniques and analyzed the value of the robotic approach. Cases of conversion have been examined in detail. Results: The mean operative times for LDP and RDP were 201.2 (SD 47.8) and 247.54 (SD 35.8) min, respectively (p=0,486). No differences were observed in length of hospital stay or conversion rate: 6 (5-34) vs. 5.6 (5-22) days, and 4 (11.4%) vs. 3 (13.6%) cases, respectively (p=0.126). The readmission rate was 3/35 patients (11.4%) treated with LDP and 6/22 (27.3%) cases of RDP (p=0.126). There were no differences in morbidity (Dindo-Clavien >= III) between the 2 groups. Mortality was one case in the robotic group (a patient with early conversion due to vascular involvement). The rate of R0 resection was greater and statistically significant in the RDP group (77.1% vs. 90.9%) (P=,04). Conclusions: Minimally invasive distal pancreatectomy (MIDP) is a safe and feasible procedure in selected patients. Surgical planning and stepwise implementation based on prior experience help surgeons successfully perform technically demanding procedures. RDP could be the approach of choice in distal pancreatectomy, and it is not inferior to LDP. (c) 2023 AEC. Published by Elsevier Espana, S.L.U. All rights reserved.

Automated summary

This study retrospectively reviewed 83 cases of distal pancreatectomy and found that minimally invasive surgery is a safe and feasible treatment option. The robotic-assisted approach is not inferior to laparoscopic surgery in distal pancreatectomy.