LAUSR

Background Robotic surgery is a novel approach that scores over conventional minimally invasive approaches, even in pancreatic surgery. We investigated clinical outcomes of robot-assisted minimally invasive (hybrid laparoscopic and robotic) pancreatoduodenectomy (RA-MIPD). Methods Total 150 patients who underwent RA-MIPD between 2015 and 2018 were compared with 710 patients who underwent open pancreatoduodenectomy (PD) during the same period. Demographics and surgical outcomes were analyzed, and propensity score-matched (PSM) analysis was performed to evaluate complications including clinically relevant postoperative pancreatic fistula (CR-POPF) and oncologic outcomes in patients with malignancy. Results PSM analysis was performed based on the pancreatic fistula risk. Patients undergoing RA-MIPD were younger (RA-MIPD vs. open PD: 61.2 vs. 65.5 years, P  < 0.001); however, no significant intergroup difference was observed in sex ( P  = 0.091) and body mass index ( P  = 0.281). Operation time was longer in the RA-MIPD group (361.2 vs. 305.7 min, P  < 0.001); however, estimated blood loss did not significantly differ (515.6 vs. 478.0 mL, P  = 0.318). Overall complication (24.7% vs. 30.9%, P  = 0.178) and CR-POPF rates (6.7% vs. 6.9%, P  > 0.999) were similar. The RA-MIPD group showed lower pain scores and shorter length of postoperative hospitalization (11.5 vs. 17.2 days, P  < 0.001). After PSM analysis for cancer and staging among patients with malignancies, no significant intergroup difference was observed in the R0 resection rate (96.7% vs. 93.3%, P  = 0.527), tumor size (2.59 vs. 2.60 cm, P  = 0.954), total number of retrieved lymph nodes (17.0 vs. 16.6, P  = 0.793), and 2-year survival rates (84.4% vs. 77.8%, P  = 0.898). Conclusions Compared with open PD, RA-MIPD is associated with better or at least similar early perioperative and equivalent midterm survival outcomes. RA-MIPD is safe and feasible and enables early postoperative recovery. RA-MIPD is expected to play a key role in near future.