Robotic‑assisted minimally invasive pancreas surgery. Review

Abstract

The use robotics in surgery is gaining momentum. This approach holds substantial promise in pancreas surgery. Minimally invasive techniques have been increasingly used in oncologic surgery and pancreatic surgery in particular. Minimally invasive pancreatectomy (MIP) has been performed with increasing frequency in all pancreatic pathologies, including pancreatic neuroendocrine tumors (PNETs), including pancreaticoduodenectomy (PD), distal pancreatectomy (DP), and pancreatic enucleation. Robotic‑assisted surgery using the DaVinci platform has accelerated the adoption of MIP. The proportion of robotic DP between 2015 and 2016 was nearly 4 times greater than between 2010 and 2012 (16% vs 4%), with a similar increase in proportion of robotic PD (7% vs 2%) over the same time frame. Advantages of robotic surgery over laparoscopy include three‑dimensional visualization, increased degrees of motion with endo‑articulation, stable camera platform, surgeon ergonomics, and single surgeon’s ability to control four instruments. Systematic adoption of MIP has been facilitated by the creation of multiple multicenter training programs in robotic DP and PD, aiming to standardize the oncologic safety and technical performance of these operations. Robotic surgery for pancreatic lesions and malignancies has become well accepted and is expanding to more and more center annually. The number of centers using robotics in pancreatic surgery is rapidly increasing. The most studied robotic pancreas surgeries are PD and DP. Most studies are in their early phases, but they report that robotic pancreas surgery is safe feasible. Robotic pancreas surgery offers several advantages over open and laparoscopic techniques. Data regarding costs of robotics versus conventional techniques is still lacking. Robotic pancreas surgery is still in its early stages. It holds promise to become the new surgical standard for pancreatic resections in the future, however, more research is still needed to establish its safety, cost effectiveness and efficacy in providing the best outcomes.