ArticleSurgical endoscopy2026
Superiority of robotic over laparoscopic distal pancreatectomy in surgical outcomes evaluated by textbook outcome.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
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11 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundThe comparative advantages of robot-assisted distal pancreatectomy (R-DP) over laparoscopic distal pancreatectomy (L-DP) remain to be fully established. This study aimed to evaluate the achievement of textbook outcomes (TO), a composite metric reflecting optimal perioperative results, in patients undergoing R-DP versus L-DP.
methodsA retrospective analysis was conducted in 180 patients who underwent minimally invasive distal pancreatectomy between February 2011 and July 2025, including 116 L-DP and 64 R-DP cases. TO was defined as the absence of conversion to open surgery, clinically relevant pancreatic fistula (CR-POPF), postpancreatectomy hemorrhage, Clavien-Dindo ≥ IIIa complications, and readmission. Logistic regression analyses were conducted to identify factors associated with TO and CR-POPF.
resultsR-DP demonstrated a significantly lower conversion rate than L-DP (L-DP vs. R-DP: 10.3 vs. 1.6%, p = 0.034). Overall TO achievement was comparable between the two groups (L-DP vs. R-DP: 65.5 vs. 75.0%, p = 0.184), with a trend favoring R-DP was observed in spleen-preserving procedures (51.8 vs. 77.3%, p = 0.082). The robotic transpancreatic mattress suture for stump closure (TP method) significantly improved TO achievement (TP method vs. other procedures: 85.7 vs. 64.8%, p = 0.016) and reduced both conversion and CR-POPF rates. Multivariate analysis identified pancreatic thickness at the transection site ≥ 12 mm (OR 4.6) and conversion to open surgery (OR 4.9) as independent risk factors for CR-POPF. Among patients with pancreatic thickness ≥ 12 mm, R-DP significantly improved TO achievement compared with L-DP (L-DP vs. R-DP: 44.7 vs. 75.0%, p = 0.005).
conclusionsR-DP significantly reduces conversion to open surgery while maintaining perioperative safety comparable to L-DP. Incorporation of the TP method into R-DP substantially improves TO achievement by reducing both conversion and CR-POPF, particularly in patients with a thick pancreas (≥ 12 mm). These findings support the clinical value of R-DP as an advantageous surgical strategy for optimizing perioperative outcomes in technically challenging cases.
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