Do we all agree that the future of pancreaticoduodenectomy lies in how effectively we use robots?

Abstract

The penetration of minimally invasive pancreaticoduodenectomy (MIPD) has been low due to the technically demanding surgical dissection, many anastomotic procedures needed, and the lack of confidence regarding the additional benefits from the minimally invasive approach compared to the conventional open approach [1]. However, retrospective series and randomized trials have reported some key advantages of MIPD, which include a decrease in intraoperative blood loss, wound complications, and postoperative pain, in addition to a shorter length of stay compared with the open pancreaticoduodenectomy (PD) [2–4]. Since robotic PD (RPD) surgery was first performed in 2003, the development of robotic platforms and the accumulation of surgical experience has meant that RPD has led to a gradual increase of adoption RPD [5]. However, no large comparative studies have been performed for RPD and laparoscopic PD (LPD), even though only a limited number of institutions perform MIPD [6]. There are two main adopters for the robotic platform in PD depending on the preference of the surgeons. Indeed, surgeons who began their MIPD journey using laparoscopy tend to prefer a hybrid approach of laparoscopic resection and robotic reconstruction, whereas other surgeons prefer a full robotic approach. There are a multitude of reasons why some surgeons prefer a hybrid approach: (1) Familiarity with the surgical devices and the operative field is a critical factor in proficient and efficacious procedures for MIPD surgeons. (2) The availability of multi-fire