Reduced-port robotic pancreatectomy: a narrative review of the literature

Abstract

Background and Objective: Minimally invasive pancreatectomy (MIP) has been increasingly performed in recent years. While the introduction of laparoscopic distal pancreatectomy (LDP) was straightforward, laparoscopic pancreaticoduodenectomy (LPD) was perceived as technically challenging due its complexity. However, robotic surgical innovation made concrete the feasibility of robotic pancreatectomy. These technological reforms have led to surgeons advocating for reduced-port surgery (RPS) for reduced procedure invasiveness. However, there are fewer reports on reduced-port robotic pancreatectomy (RPRP) than on other types of robotic surgery. Minimally invasive surgery (MIS) has lagged behind most in this area due to the complexity of pancreatectomy. In this narrative review, we provide a comprehensive overview of the evolution of RPRP. Methods: Original manuscripts on RPRP, written in English and published before May 30, 2022, were searched for in the PubMed, Embase and Cochrane databases. Keywords included “single-port”, “single-site”, or “single-incision” robotic pancreatectomies. Key Content and Findings: The search revealed seven studies reporting 104 cases of RPRP, including 59 and 45 cases of distal pancreatectomy (DP) and pancreaticoduodenectomy (PD), respectively. Although there were only two studies comparing reduced-port laparoscopic pancreatectomies and open or laparoscopic pancreatectomy, perioperative outcomes were acceptable for both DP and PD. Only five patients in this review required conversion to multi-port or open surgery (4.8%). Although the small number of material papers in this review may not conclusively guide the next steps in this surgery, we found no evidence to disprove the feasibility of RPRP. Conclusions: Based on the results of further comparative studies with conventional robotic pancreatectomy, we hope that RPRP will become more widely used in the future.