Robotic versus laparoscopic spleen-preserving distal pancreatectomy: a propensity score-matched study of the "splenic artery and vein plane first" strategy.

This study aims to compare the intraoperative and short-term postoperative efficacies between robotic-assisted and conventional laparoscopic approaches for spleen-sparing left pancreatectomy. Both minimally invasive modalities were executed by adopting the Splenic Artery and Vein Anatomical Plane First (SAPP) surgical philosophy. A retrospective assessment was conducted on patients who received minimally invasive distal pancreatectomies with Kimura-style splenic preservation from January 2019 to September 2024. To mitigate potential selection bias and equilibrate baseline variables across the cohorts, a 1:1 propensity score matching (PSM) protocol was implemented. Subsequent comparative analyses focused on both intraoperative metrics and postoperative clinical outcomes within the matched pairs. Of the 113 total participants, those undergoing robotic spleen-preserving distal pancreatectomy (RSPDP) experienced notably less intraoperative bleeding than those in the laparoscopic spleen-preserving distal pancreatectomy (LSPDP) group (P = 0.039). This trend remained robust after PSM, which yielded 54 patients in 27 matched pairs; the RSPDP group maintained a significant advantage in minimizing blood loss (49.07 ± 34.64 mL vs. 78.15 ± 57.31 mL, P = 0.028). Regarding other perioperative metrics—specifically operative time, fistula occurrence, overall morbidity, and length of stay or readmission—the two approaches yielded comparable results with no significant variations observed. Both robotic and laparoscopic platforms demonstrate comparable and safe perioperative outcomes for spleen-preserving distal pancreatectomy under the SAPP framework. While the robotic approach offers a modest, statistically significant advantage in mitigating intraoperative blood loss during complex vascular skeletonization, its macroscopic clinical relevance requires further evaluation.