Robotic central pancreatectomy and pancreatogastrostomy: surgical technique and review of literature

Improved imaging techniques, coupled with more frequent cross-sectional imaging, have led to a recent rise in the detection of low-grade pancreatic lesions, including intraductal papillary mucinous neoplasms (IPMN), mucinous cystic neoplasms (MCN), pancreatic neuroendocrine tumors (PNET) and solid pseudopapillary tumors (SPEN). Consequently, in addition to more routine procedures to treat resectable pancreatic lesions such as the pancreaticoduodenectomy (PD) and distal pancreatectomy (DP), the use of central pancreatectomy (CP) to resect low-grade, mid-pancreatic tumors has increased. The aim of a CP is the removal of disease while maintaining optimal preservation of the surrounding pancreatic parenchyma. It has been demonstrated that open CP is safe and efficacious, but literature on robotic CP is limited. The aim of this manuscript was to describe the technique of robotic CP and review the current literature. PubMed, Embase and Google Scholar were reviewed to identify literature on robotic CP. Twelve articles reporting 116 patients were identified and data were collected. The overall morbidity and mortality was 64.7%, and 0.0% respectively. Reoperation was required in 1.7% patients, and 56.9%, and 0.9% developed postoperative pancreatic fistula (POPF) and diabetes mellitus (DM) respectively. No postoperative exocrine insufficiency. These outcomes were comparable to those reported for open and laparoscopic CP. Robotic CP is a safe procedure when performed by trained surgeons at high-volume centers.