Anatomy-based individualised trocar placement in robotic pancreatic surgery: challenging the universal approach.

Robotic pancreatic surgery has advanced considerably in recent years; however, morbidity and mortality remain significant. Improving outcomes requires standardised procedures with optimised perioperative settings. Proper positioning of robotic trocars plays a key role in enabling safe and effective surgical performance. This study evaluates the impact of anthropometric differences on trocar placement in robotic pancreatic surgery and assesses the feasibility of a universal trocar placement strategy. A retrospective analysis of 103 consecutive contrast-enhanced arterial-phase computed tomography scans was performed. Key distances between the target anatomy and surface landmarks, including the umbilicus and xiphoid process, were measured. The origin of the gastroduodenal artery was selected as the target anatomy for pancreaticoduodenectomy, while the origin of the celiac trunk served as the target anatomy for distal pancreatectomy. The analysis demonstrated that the widely adopted universal periumbilical trocar placement was unsuitable for a substantial proportion of patients. The target anatomy lay outside the recommended range (10–20 cm) in 24% of robotic pancreaticoduodenectomy cases and in 9% of robotic distal pancreatectomy cases. Accordingly, we propose a simple method to optimise patient-tailored yet standardised trocar placement in robotic pancreatic procedures.