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Purpose <p>The robotic approach has been increasingly used for complex pancreatic surgery, including Pancreatoduodenectomy (PD), yet variability in techniques limits reproducibility. This dynamic manuscript shows a standardized operative sequence for a single surgeon (without the need for a surgeon at the bedside) for robotic PD.</p> Methods <p>We retrospectively reviewed consecutive patients who underwent RPDs between January 2020 and July 2025, representing the plateau phase of a robotic program initiated in 2012. Demographic, operative, and postoperative variables were collected from a prospectively maintained database. The operative technique was standardized into defined steps for exposure, resection, and reconstruction, including preferred techniques of pancreatojejunostomy, hepaticojejunostomy, and duodenojejunostomy.</p> Results <p>Among a total of 270 RPD, 129 procedures were done from 2020 until 2025 and represent the most mature phase of our program, with a median age of 69&#xa0;years; 86% had malignancy, and 72.9% underwent pylorus-preserving procedures. Median estimated blood loss was 200&#xa0;mL, transfusion rate 15%, and operative time 429&#xa0;min. Conversion to open surgery occurred in 14%, predominantly for vascular resection. Median length of stay was 7&#xa0;days, 90-day readmission was 31%, and mortality was 2.3%. High-grade complications (Clavien–Dindo ≥ III) occurred in 27%, with delayed gastric emptying in 10.8% and grade C pancreatic fistula in 7.8%.</p> Conclusions <p>A standardized, stepwise technique for a single surgeon RPD enables consistent and safe outcomes in a high-volume program. Technical reproducibility appears essential for optimal perioperative outcomes, surgical training, and broader adoption of RPD.</p>

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Standardization of single surgeon robotic pancreatoduodenectomy: lessons from 2 decades of stepwise robotic HPB surgery

  • 期刊论文

  • 发表日期：

    2026年3月23日

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  • Raphael L. C. Araujo,
  • Zuhaib M. Mir,
  • Marleny N. F. Araujo,
  • Valeria Arango,
  • Dionisios Vrochides,
  • John B. Martinie

摘要

Purpose

The robotic approach has been increasingly used for complex pancreatic surgery, including Pancreatoduodenectomy (PD), yet variability in techniques limits reproducibility. This dynamic manuscript shows a standardized operative sequence for a single surgeon (without the need for a surgeon at the bedside) for robotic PD.

Methods

We retrospectively reviewed consecutive patients who underwent RPDs between January 2020 and July 2025, representing the plateau phase of a robotic program initiated in 2012. Demographic, operative, and postoperative variables were collected from a prospectively maintained database. The operative technique was standardized into defined steps for exposure, resection, and reconstruction, including preferred techniques of pancreatojejunostomy, hepaticojejunostomy, and duodenojejunostomy.

Results

Among a total of 270 RPD, 129 procedures were done from 2020 until 2025 and represent the most mature phase of our program, with a median age of 69 years; 86% had malignancy, and 72.9% underwent pylorus-preserving procedures. Median estimated blood loss was 200 mL, transfusion rate 15%, and operative time 429 min. Conversion to open surgery occurred in 14%, predominantly for vascular resection. Median length of stay was 7 days, 90-day readmission was 31%, and mortality was 2.3%. High-grade complications (Clavien–Dindo ≥ III) occurred in 27%, with delayed gastric emptying in 10.8% and grade C pancreatic fistula in 7.8%.

Conclusions

A standardized, stepwise technique for a single surgeon RPD enables consistent and safe outcomes in a high-volume program. Technical reproducibility appears essential for optimal perioperative outcomes, surgical training, and broader adoption of RPD.