Robotic Pancreatoduodenectomy: Results of the First Twenty Procedures

Introduction: Minimally invasive surgery is gaining momentum in pancreatoduodenectomy. Presumed benefits include fewer major complications, less blood loss and a shorter hospital stay. However, conventional laparoscopy is hindered by the straight, non-articulating instrumentation. The robot was designed to overcome these technical restrictions. The aim of this study was to demonstrate safety and feasibility of robotic pancreatoduodenectomy. Methods: Patients underwent robotic pancreatoduodenectomy in two centers in the Netherlands, performed by the same surgical team, between March 2016 and September 2017. Patients were selected in a multidisciplinary meeting. Tumors with vascular involvement were excluded. Data were prospectively collected. Postoperative outcomes were scored up to 90 days after resection. Results: In total, twenty robotic pancreatoduodenectomies were performed. Two procedures were converted to an open procedure: one due to failure to progress and one due to a portal bleeding that could not be controlled robotically. Median operative time was 415 min. (IQR: 355–457). Median blood loss was 325 mL (IQR: 178–675). Four patients had postoperative pancreatic fistula (ISGPS gr. B/C). Eight patients suffered from delayed gastric emptying (ISGPS gr. B/C). One patient had a bile leak (ISGLS gr. C). One patient suffered from post-pancreatectomy hemorrhage (ISGPS gr. C). In total, ten patients had a major complication (≥ gr. III Clavien-Dindo). There were no grade IV postoperative complications and there was no mortality. Median length of hospital stay was 16 days (IQR: 9–24). Five patients had to be readmitted within 90 days for surgery-related complications. Conclusion: Robotic pancreatoduodenectomy is safe and feasible in selected patients.