Robot‑Assisted Pancreatoduodenectomy as a Treatment Option for Tumors in the Head of the Pancreas

Introduction. Pancreatoduodenectomy is among the most technically demanding procedures in abdominal surgery. Recent developments in minimally invasive techniques, particularly laparoscopic and robotic systems, have reshaped operative strategies. Robotic systems offer several technical advantages over conventional laparoscopy, which may be especially advantageous in pancreatic surgery. Aim. This study evaluated the effectiveness and safety of robot‑assisted pancreatoduodenectomy.

Materials and methods. This study was conducted in the surgical department of the BSMU Clinic from September 2020 to September 2025. 27 patients undergoing operative treatment were included. Group 1 comprised 12 patients who underwent robot‑assisted pancreatoduodenectomy; Group 2 included 15 patients who underwent an open procedure. Perioperative outcomes and early and late postoperative complications were assessed and stratified according to the Clavien–Dindo classification. Statistical analysis was performed using Microsoft Office 2024 and IBM SPSS Statistics 27, with statistical significance set at p < 0.05.

Results and discussion. Preoperative characteristics exhibited no significant difference between groups (p > 0.05). Intraoperatively, Group 1 had significantly lower blood loss (p < 0.001), although operative time was longer than in Group 2 (p < 0.001). Postoperatively, Group 1 demonstrated faster recovery of bowel function (p < 0.001) and a shorter hospital stay (p = 0.004). Although thirty‑day postoperative complications occurred more frequently in Group 2 (46.7%), the difference between groups was statistically insignificant (p = 0.419). The advantages of the robotic approach are attributed to reduced operative trauma and greater precision during dissection and reconstruction.

Conclusion. Robot‑assisted pancreatoduodenectomy is an effective and safe option for the radical treatment of tumors of the pancreaticoduodenal region.

1. Emmen A.M.L.H., Ali M., Groot Koerkamp B., Boggi U., Molenaar I.Q., Busch O.R., et al. Predicting postoperative pancreatic fistula after robotic pancreatoduodenectomy using International Study Group on Pancreatic Surgery and fistula risk scores: European multicentre retrospective cohort study. BJS Open. 2025;9(3):zraf036. DOI: 10.1093/bjsopen/zraf036

2. Stoffel E.M., Brand R.E., Goggins M. Pancreatic cancer: changing epidemiology and new approaches to risk assessment, early detection, and prevention. Gastroenterology. 2023;164(5):752–65. DOI: 10.1053/j.gastro.2023.02.012

3. Goggins M., Overbeek K.A., Brand R., Syngal S., Del Chiaro M., Bartsch D.K., et al. Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium. Gut. 2020;69(1):7–17. DOI: 10.1136/gutjnl-2019-319352

4. Duan H., Li L., He S. Advances and prospects in the treatment of pancreatic cancer. Int J Nanomedicine. 2023;18:3973–988. DOI: 10.2147/IJN.S413496

5. Torphy R.J., Fujiwara Y., Schulick R.D. Pancreatic cancer treatment: better, but a long way to go. Surg Today. 2020;50(10):1117–25. DOI: 10.1007/s00595-020-02028-0

6. Kim J.S., Choi M., Hwang H.S., Lee W.J., Kang C.M. The Revo-i Robotic Surgical System in advanced pancreatic surgery: a second non-randomized clinical trial and comparative analysis to the da Vinci™ system. Yonsei Med J. 2024;65(3):148–55. DOI: 10.3349/ymj.2023.0140

7. Jin J., Shi Y., Chen M., Qian J., Qin K., Wang Z., et al. Robotic versus open pancreatoduodenectomy for pancreatic and periampullary tumors (PORTAL): a study protocol for a multicenter phase III non-inferiority randomized controlled trial. Trials. 2021;22(1):954. DOI: 10.1186/s13063-021-05939-6

8. Rebelo A., Rauchbach E., Kleeff J., Klose J. Postoperative chyle leak after pancreatic surgery: scoping review. BJS Open. 2025;10(1):zraf146. DOI: 10.1093/bjsopen/zraf146

9. Emmen A.M.L.H., van den Broek B.L.J., Hendriks T.E., Busch O.R., Bonsing B.A., Cappelle M.L., et al. Nationwide outcomes of 1000 robotic pancreatoduodenectomies across the four phases of the learning curve. Br J Surg. 2025;112(11):znaf210. DOI: 10.1093/bjs/znaf210

10. Abu Hilal M., van Ramshorst T.M.E., Boggi U., Dokmak S., Edwin B., Keck T., et al. The Brescia internationally validated european guidelines on minimally invasive pancreatic surgery (EGUMIPS). Ann Surg. 2024;279(1):45–57. DOI: 10.1097/SLA.0000000000006006

11. Asbun H.J., Moekotte A.L., Vissers F.L., Kunzler F., Cipriani F., Alseidi A., et al. The Miami international evidence-based guidelines on minimally invasive pancreas resection. Ann Surg. 2020;271(1):1–14. DOI: 10.1097/SLA.0000000000003590

12. Liu R., Abu Hilal M., Besselink M.G., Hackert T., Palanivelu C., Zhao Y., et al. International consensus guidelines on robotic pancreatic surgery in 2023. Hepatobiliary Surg Nutr. 2024;13(1):89–104. DOI: 10.21037/hbsn-23-132

13. Belotto M., Torres O.J.M. Robotic pancreatoduodenectomy in Brazil: lessons after 15 years of the first case. Arq Bras Cir Dig. 2024;37:e1822. DOI: 10.1590/0102-6720202400029e1822

14. Valukas C.S., Zaza N.M., Vitello D., Odell D.D., Merkow R., Bentrem D.J. A comparative analysis of open versus minimally invasive pancreatoduodenectomies. J Surg Oncol. 2025;131(5):816–26. DOI: 10.1002/jso.27992

15. Wakabayashi T., Gaudenzi F., Nie Y., Mishima K., Fujiyama Y., Igarashi K., et al. Reduced pancreatic fistula rates and comprehensive cost analysis of robotic versus open pancreaticoduodenectomy. Surg Endosc. 2025;39(6):3921–9. DOI: 10.1007/s00464-025-11768-4

16. Li R., Zhang X., Chen W., Ye Y., Li X., Chen Y., et al. Robotic pancreatoduodenectomy reduces grade B pancreatic fistula in patients with a small main pancreatic duct: a propensity score-matched study compared to laparoscopic pancreatoduodenectomy. Ann Med. 2025;57(1):2527357. DOI: 10.1080/07853890.2025.2527357

17. Napoli N., Kauffmann E.F., Vistoli F., Amorese G., Boggi U. State of the art of robotic pancreatoduodenectomy. Updates Surg. 2021;73(3):873–80. DOI: 10.1007/s13304-021-01058-8

18. Delvecchio A., Caringi S., De Palma C., Brischetto G., Filippo R., Casella A., et al. Step-by-step description of standardized technique for robotic pancreatoduodenectomy. Curr Oncol. 2025;32(6):302. DOI: 10.3390/curroncol32060302

19. Kuriyama N., Fujii T., Kaluba B., Sakamoto T., Komatsubara H., Noguchi D., et al. Short-term surgical outcomes of open, laparoscopic, and robot-assisted pancreatoduodenectomy: A comparative, single-center, retrospective study. Asian J Endosc Surg. 2025;18(1):e13397. DOI: 10.1111/ases.13397

20. Petric M., Polanco P.M., Grosek J., Tomazic A., Trotovsek B., Plesnik B. The implementation of a robotic surgical platform for the treatment of patients with malignant or pre-malignant pancreatic tumors at the University Medical Center Ljubljana. Radiol Oncol. 2025;59(3):425–34. DOI: 10.2478/raon-2025-0051

21. Müller P.C., Kuemmerli C., Cizmic A., Sinz S., Probst P., de Santibanes M., et al. Learning curves in open, laparoscopic, and robotic pancreatic surgery: a systematic review and proposal of a standardization. Ann Surg Open. 2022;3(1):e111. DOI: 10.1097/AS9.0000000000000111

22. de Graaf N., Zwart M.J.W., van Hilst J., van den Broek B., Bonsing B.A., Busch O.R., et al. Early experience with robotic pancreatoduodenectomy versus open pancreatoduodenectomy: nationwide propensity-score-matched analysis. Br J Surg. 2024;111(2):znae043. DOI: 10.1093/bjs/znae043

23. Nartailakov M.A., Garaev M.R., Salimgareev I.Z., Dorofeev V.D., Petrov Yu.V., Sokolov S.V., et al. Intraperitoneal purulent-septic complications in surgery of organs of the hepatopancreatobiliary zone: possibilities of modern methods of correction. Creative surgery and oncology. 2025;15(3):228–34 (In Russ.). DOI: 10.24060/2076-3093-2025-15-3-228-234

24. Kauffmann E.F., Napoli N., Ginesini M., Gianfaldoni C., Asta F., Salamone A., et al. Tips and tricks for robotic pancreatoduodenectomy with superior mesenteric/portal vein resection and reconstruction. Surg Endosc. 2023;37(4):3233–45. DOI: 10.1007/s00464-022-09860-0

25. Kriger A.G., Berelavichus S.V., Gorin D.S., Kaldarov A.R., Karel’skaia N.A., Akhtanin E.A. Robot-assisted pancreatoduodenectomy. Pirogov Russian Journal of Surgery. 2015;9:50–6 (In Russ.). DOI: 10.17116/hirurgia2015950-56

26. Assawasirisin C., Han Y., Jung H.S., Yun W.G., Chae Y.S., Kwon W., et al. Comparison of pancreatic fistula between robotic-assisted and open pancreatoduodenectomy: a comprehensive evaluation using an alternative fistula risk score. J Hepatobiliary Pancreat Sci. 2025;32(9):689–97. DOI: 10.1002/jhbp.12167

27. Morelli L., Furbetta N., Palmeri M., Guadagni S., Di Franco G., Gianardi D., et al. Initial 50 consecutive full-robotic pancreatoduodenectomies without conversion by a single surgeon: a learning curve analysis from a tertiary referral high-volume center. Surg Endosc. 2023;37(5):3531–9. DOI: 10.1007/s00464-022-09784-9

28. Hays S.B., Rojas A.E., Hogg M.E. Robotic pancreas surgery for pancreatic cancer. Int J Surg. 2024;110(10):6100–10. DOI: 10.1097/JS9.0000000000000906

29. Zwart M.J.W., van den Broek B., de Graaf N., Suurmeijer J.A., Augustinus S., Te Riele W.W., et al. The feasibility, proficiency, and mastery learning curves in 635 robotic pancreatoduodenectomies following a multicenter training program: “Standing on the Shoulders of Giants”. Ann Surg. 2023;278(6):e1232–41. DOI: 10.1097/SLA.0000000000005928

30. Kauffmann E.F., Napoli N., Ginesini M., Gianfaldoni C., Asta F., Salamone A., et al. Feasibility of “cold” triangle robotic pancreatoduodenectomy. Surg Endosc. 2022;36(12):9424–34. DOI: 10.1007/s00464-022-09411-7

31. Emmen A.M.L.H., Görgec B., Zwart M.J.W., Daams F., Erdmann J., Festen S., et al. Impact of shifting from laparoscopic to robotic surgery during 600 minimally invasive pancreatic and liver resections. Surg Endosc. 2023;37(4):2659–72. DOI: 10.1007/s00464-022-09735-4

32. Zong K., Luo K., Chen K., Ye J., Liu W., Zhai W. A comparative study of robotics and laparoscopic in minimally invasive pancreatoduodenectomy: A single-center experience. Front Oncol. 2022;12:960241. DOI: 10.3389/fonc.2022.960241