A new consensus on robotic pancreas surgery has been prepared by a panel of international experts.
Key among the recommendations are the following:
- Robotic distal pancreatectomy (RDP) is associated with similar lymph nodes harvest number and equivalent margin status as laparoscopic distal pancreatectomy (LDP) in cases of malignant disease.
- No significant difference in spleen-preserving rate between RDP and LDP.
- For malignant tumours, robotic pancreaticoduodenectomy (RPD) is associated with higher R0 resection rate but similar lymph node harvest vs open pancreaticoduodenectomy (OPD).
- RPD can be employed for benign or malignant disease at the pancreas head and duodenum, and for large benign tumours, advanced stage malignancies or conditions that need resection and reconstruction of involved vessels.
- RPD has comparable perioperative mortality, post-operative complication rate and rate of post-operative pancreatic fistula as OPD.
- Robotic central pancreatectomy (RCP) is safe and feasible for benign and borderline tumours in the neck and proximal body of the pancreas.
- Insufficient evidence to show short-term outcomes are better with RCP vs open central pancreatectomy.
- Robotic pancreatic enucleation (RPE) can be applied in superficial benign tumours (safe distance from margin to main pancreatic duct (MPD) should be ≥2 mm).
- When the MPD is injured during RPE, one-stage repair is feasible, but safety needs to be evaluated.