ArticleSurgical endoscopy2026
Standardization of single surgeon robotic pancreatoduodenectomy: lessons from 2 decades of stepwise robotic HPB surgery.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
purposeThe robotic approach has been increasingly used for complex pancreatic surgery, including Pancreatoduodenectomy (PD), yet variability in techniques limits reproducibility. This dynamic manuscript shows a standardized operative sequence for a single surgeon (without the need for a surgeon at the bedside) for robotic PD.
methodsWe retrospectively reviewed consecutive patients who underwent RPDs between January 2020 and July 2025, representing the plateau phase of a robotic program initiated in 2012. Demographic, operative, and postoperative variables were collected from a prospectively maintained database. The operative technique was standardized into defined steps for exposure, resection, and reconstruction, including preferred techniques of pancreatojejunostomy, hepaticojejunostomy, and duodenojejunostomy.
resultsAmong a total of 270 RPD, 129 procedures were done from 2020 until 2025 and represent the most mature phase of our program, with a median age of 69 years; 86% had malignancy, and 72.9% underwent pylorus-preserving procedures. Median estimated blood loss was 200 mL, transfusion rate 15%, and operative time 429 min. Conversion to open surgery occurred in 14%, predominantly for vascular resection. Median length of stay was 7 days, 90-day readmission was 31%, and mortality was 2.3%. High-grade complications (Clavien-Dindo ≥ III) occurred in 27%, with delayed gastric emptying in 10.8% and grade C pancreatic fistula in 7.8%.
conclusionsA standardized, stepwise technique for a single surgeon RPD enables consistent and safe outcomes in a high-volume program. Technical reproducibility appears essential for optimal perioperative outcomes, surgical training, and broader adoption of RPD.
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