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Jiao et al. Art Int Surg 2023;3:98-110 Artificial
DOI: 10.20517/ais.2023.03
Intelligence Surgery

Technical Note Open Access

Robotic pancreatoduodenectomy - how I do it: tips,
tricks and pitfalls to standardize the technique to

reduce postoperative morbidity and mortality

1,2
1
Long R. Jiao , Rajendran Vellaisamy , Tamara Gall 1
1
Department of Surgery, The Royal Marsden Hospital, London SW3 6JJ, UK.
2
Hepato-Pancreato-Biliary (HPB) Surgical Unit, Department of Surgery and Cancer, Imperial College, London W12 0HS, UK.
Correspondence to: Prof. Long R. Jiao, Department of Surgery, The Royal Marsden Hospital, 203 Fulham Road, London SW3
6JJ, UK. E-mail: l.jiao@imperial.ac.uk

How to cite this article: Jiao LR, Vellaisamy R, Gall T. Robotic Pancreatoduodenectomy - how I do it: tips, tricks and pitfalls to
standardize the technique to reduce postoperative morbidity and mortality. Art Int Surg 2023;3:98-110.
https://dx.doi.org/10.20517/ais.2023.03
Received: 29 Jan 2023 First Decision: 3 April 2023 Revised: 11 April 2023 Accepted: 26 April 2023 Published: 9 May 2023

Academic Editors: Henry A. Pitt, Andrew A. Gumbs, Fabio Ausania Copy Editor: Ke-Cui Yang Production Editor: Ke-Cui Yang

Abstract
Pancreatoduodenectomy (PD) is increasingly performed laparoscopically (LPD) and robotically (RPD) with the
benefits of minimally invasive surgery and equivalent oncological outcomes compared with conventional open PD
(OPD). When LPD and RPD are compared, RPD offers better precision with 3D vision and advanced
instrumentation. Although the learning curve for RPD is long with a longer operating time compared with OPD, this
can be reduced to a duration similar to that for OPD through standardization of techniques and case numbers.
Perioperative outcomes such as length of stay, blood loss, and transfusion requirement are significantly improved
compared to OPD and fewer cases require conversion to open than LPD. In this article, we describe our approach
to RPD through standardizing PD techniques along with tips and tricks for the benefit of surgeons interested in
learning robotic pancreatic surgery.
Keywords: Whipple’s, PD-pancreatoduodenectomy, Robotic Whipple’s, OPD-open pancreatoduodenectomy, LPD-
laparoscopic pancreatoduodenectomy, RPD-robotic pancreatoduodenectomy, pancreatic resection, pancreatic
cancer

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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