Robotic pancreaticoduodenectomy versus laparoscopic pancreaticoduodenectomy

Abstract

Robotic and laparoscopic pancreaticoduodenectomy have both been shown to have similar outcomes compared to the open technique, however, few large trials have compared the efficacy and outcomes of RPD and LPD. As an oncological operation, the key considerations for minimally invasive pancreaticoduodenectomy are peri-operative outcomes, oncologic outcomes, and feasibility. The optimal approach should offer non-inferior mortality, morbidity, and oncologic outcomes compared to the open approach. The new approach should also be technically feasible. RPD has been shown in the literature to be as safe, with comparable morbidity and mortality, as OPD and with no significant difference compared to LPD. RPD is less likely than LPD to convert to open, reducing potential operative times and complications. High volume centers have begun to demonstrate shorter operative times with RPD than LPD, a trend that is expected to progress as the technology and technique is more widely adopted. Similar high volume centers have also experienced less transfusion requirements with RPD than LPD and significantly less estimated blood loss with either MIPD compared with OPD. Oncologic outcomes such as R0 resection rates and lymph node harvest are similar between RPD and OPD both in the largest multi-center trial by Zureikat et al. and in database analyses. Robotic surgery in general has advantages of magnification, greater degrees of freedom, and high fidelity training modules compared to laparoscopy. LPD has been hindered in part by its technical difficulty with most studies including less than 50 patients each. Both RPD and LPD have been shown to be safe and effective alternatives to OPD. There is limited high level evidence comparing RPD and LPD but RPD offers several advantages. We expect that RPD will become increasingly widespread as more data emerges and the technology continues to mature.