Initial experience of robotic-assisted pancreaticoduodenectomy using the da Vinci SP system.

Abstract

Background: In the era of robotic surgery, pancreatoduodenectomy (PD) has been performed with the Xi system. Recently, the advent of the SP system has allowed more minimally invasive surgery with reduced ports. We have applied the SP system to perform PD. We aimed to report our initial experience of robotic-assisted PD using the da Vinci single-port (SP) system to demonstrate the safety and feasibility of this platform.

Methods: We retrospectively reviewed patients who underwent robotic-assisted pylorus-preserving pancreaticoduodenectomy (PPPD) between 2021 and 2023 at a single center. Robotic PPPD was performed using the da Vinci SP system with either four or two additional ports, utilizing a laparoscopic hybrid technique.

Results: Of the 14 patients, six underwent the SP + 4 ports approach, and eight underwent the SP + 2 ports approach. The mean patient age was 60.2 years, and the mean body mass index was 22.5 ± 2.3 kg/m². The mean operative time was 444.29 ± 59.6 min, with an estimated intraoperative blood loss of < 500 ml in all cases. There were two cases of postoperative pancreatic fistula and one case of bile leak.

Conclusion: Robot-assisted PPPD using the da Vinci SP system is safe and feasible, with acceptable perioperative outcomes. We also report a successful SP + 2 port PPPD. Owing to the unique structure of the da Vinci SP system, our method has the potential to reduce the number of trocar sites and provide a gateway for better, minimally invasive surgeries. However, further reports assessing the experience are essential to establish its wide clinical practice.