Robotic Surgeries in Benign and Malignant Pancreatic Disease

Pancreatic resection stands as one of the most challenging abdominal surgeries, primarily indicated for pancreatic malignancies such as pancreatic ductal adenocarcinoma (PDAC), pre-malignant conditions like intraductal papillary mucinous neoplasm (IPMN), and benign pathologies that manifest with significant symptoms, including intractable pain, often concomitant with endocrine or exocrine dysfunction. The inherent complexity and morbidity associated with pancreatic resection, exacerbated by the high risk of pancreatic anastomosis complications, including pancreatic leaks of amylase-rich fluid, is further amplified by the pancreas’s retroperitoneal location near vital anatomical structures. This underscores the imperative need for a thorough assessment of emerging surgical approaches, with particular attention to the application of robotic technology. This review appraises the impact of robotic-assisted surgery on the operative and oncological outcomes of patients afflicted with benign and malignant, pancreatic and peri-pancreatic, diseases. Robotic surgery has exhibited a correlation with enhanced post-operative outcomes such as reduced morbidity and mortality following pancreatic resections. Furthermore, it has demonstrated a positive association with improved oncological resection and outcomes in patients diagnosed with pancreatic and peri-pancreatic cancer. Minimally invasive surgery has substantially refined the landscape of pancreatic resections, offering diminished post-operative pain and reduced hospital stay. Robotic surgery, distinguished by its superior visualization and meticulous tissue handling capabilities, enables precise dissection and seamless anastomosis in the complex realm of pancreatic surgery. Consequently, this has translated into ameliorated morbidity and mortality in this patient cohort, emphasizing the critical role of surgeon proficiency and case volume. Minimally invasive resection in the context of malignancy has demonstrated favorable oncological outcomes. This is potentially attributed to improved oncological resection (increased negative margins and lymph node yield) expedited post-operative recovery, facilitating prompt initiation of adjuvant therapy and attenuating surgical stress-induced tumorigenesis. Nonetheless, future randomized controlled trials are indispensable to comprehensively elucidate the impact of robotic resection on the host immune response and long-term outcomes following pancreatic resections, encompassing both benign and malignant etiologies. Such investigations hold the promise of advancing our understanding and optimizing the role of robotic surgery in the context of pancreatic diseases.