Robotic surgery of the pancreas: the current state

Abstract

Introduction: Pancreatic surgery is one of the most challenging areas of general surgery. Robotic-assisted surgery is increasingly used in surgery and especially in pancreatic surgery. As with the introduction of any new technology this method must be carefully studied before it can be widely adopted in pancreatic surgery. Materials and Methods: The articles used for this systematic review were selected from Pubmed and the studies included were only the studies with robotic-assisted pancreatic surgery of the last 8 years, using the keywords “robotic pancreatectomy” and “robotic pancreatic surgery”. Series with less than 5 procedures performed were excluded by the analysis and reported eventually to describe particular aspects or techniques. Results: The studies showed that robotic-assisted pancreatic surgery as a minimally invasive method is possible and safe and the results are equivalent, if not better, compared to conventional open surgery because of shorter length of stay in the hospital, less chance of postoperative infections. Both robotic pancreatoduodenectomy and distal pancreatectomy have conducive or similar outcomes to conventional procedures. However there are some disadvantages such as longer duration of surgery, doubts about whether oncological results and cost effectiveness are really adequate for robotic surgery. Evidence for any oncological benefits of this technique is currently lacking as the advantages of cosmetic robotic surgery are insufficient to justify widespread use in cancer patients. In contrast the safety of this procedure may justify the use of robotic surgery technique in patients with benign or low-grade malignant pancreatic tumors. Conclusion: Most of the articles conclude that the position of robotic-assisted pancreatic surgery in the field of minimally invasive surgery remains ambiguous. Further randomized controlled clinical trials urgently need to be performed especially considering the great technological development potential of robotic surgery.