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Riachi et al. Mini-invasive Surg 2023;7:14 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2022.120

Review Open Access

Advances in pancreas surgery: robotic

pancreaticoduodenectomy

Mansour E. Riachi, D. Brock Hewitt
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, NYU Grossman School of Medicine, New York,
NY10016, USA.

Correspondence to: D. Brock Hewitt, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, NYU
Grossman School of Medicine, 530 First Avenue, 7V, New York, NY 10016, USA. E-mail: brock.hewitt@nyulangone.org

How to cite this article: Riachi ME, Hewitt DB. Advances in pancreas surgery: robotic pancreaticoduodenectomy. Mini-invasive
Surg 2023;7:14. https://dx.doi.org/10.20517/2574-1225.2022.120

Received: 22 Dec 2022 First Decision: 27 Feb 2023 Revised: 14 Mar 2023 Accepted: 23 Mar 2023 Published: 20 Apr 2023

Academic Editors: Fernando A. Alvarez, Giulio Belli Copy Editor: Ke-Cui Yang Production Editor: Ke-Cui Yang

Abstract
Surgeon technical improvements made in the 1980s significantly decreased the morbidity and mortality associated
with pancreaticoduodenectomy (PD). While minimally invasive surgery (MIS) is now the standard surgical
approach for many benign and malignant pathologies, the technical complexity associated with PD presents many
challenges to MIS adoption. However, advancements in robotic technology have done much to ameliorate
mechanical impediments. Compared to laparoscopic surgery, the robotic platform provides surgeons with
enhanced visualization, greater degrees of freedom and range of motion, tremor elimination, and superior
ergonomic positioning. Although cost and availability concerns persist, training programs have increasingly
incorporated robotic curricula, boosting the prevalence of robotic procedures, including robotic PD (RPD). While
prospective data are limited, studies evaluating RPD demonstrate safety, equivalent short-term oncological
outcomes, and longer operating times compared to open PD. Furthermore, exciting avenues exist for the future of
RPD, ranging from continued instrument innovations to AI-enhanced adjuncts. Robotics has the potential to
improve PD for patients and surgeons alike; however, further evaluation of oncologic and surgical outcomes
requires well-powered, randomized, prospective trials to confirm the results of earlier retrospective studies, given
the significant biases present. In this article, we review the progression of minimally invasive PD, present outcomes
from studies evaluating RPD, and discuss areas of innovation for RPD.

Keywords: Pancreaticoduodenectomy, whipple, robotic surgery, robotic pancreaticoduodenectomy

© 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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