ArticleAnnals of surgical oncology2026
Enhancing the Workflow of Full Robotic Pancreatoduodenectomy: A Counterclockwise Step-by-Step Approach to Resection and Reconstruction.
Article in Annals of surgical oncology, 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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12 authors.
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Abstract
backgroundRobotic technology has enabled the execution of complex surgical procedures through a fully minimally invasive approach. Among these procedures, robotic pancreatoduodenectomy (R-PD) remains particularly challenging due to its duration and the numerous steps involved. The authors present a standardized approach designed as a reproducible framework potentially applicable to the majority of standard R-PD techniques aimed at enhancing operative workflow.
methodsThe technique is based on a stepwise model for the resection phase, performed in a counterclockwise sequence that provides a logical and reproducible pathway through the complex anatomy of the pancreatic head. The reconstruction phase follows a second counterclockwise-inspired sequence, relying on standardized anastomotic techniques designed to improve reproducibility and operative flow.
resultsBetween May 2018 and November 2025, 150 consecutive R-PDs were performed in our General Surgery Unit. The mean console time was 279.44 ± 55.85 min. All the procedures were completed using a fully robotic approach, without conversion to open surgery. The median hospital stay was 12 days (range, 9-23 days). Major complications (Clavien-Dindo ≥3) occurred for 20 patients (13.3 %). Clinically relevant postoperative pancreatic fistula developed in 10 patients (6.7 %), whereas clinically relevant delayed gastric emptying was reported in 35 patients (23.3 %). The 30- and 90-day mortality rates were 1.3 % (2/150 patients) and 3.3 % (5/150 patients), respectively.
conclusionsThe structured, counterclockwise-inspired surgical sequence described combined with standardized reconstruction techniques may represent an effective strategy for performing most standard R-PDs. This approach has the potential to streamline workflow and enhance surgical outcomes.
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