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Updated: Jan 1, 2026
Robotic Central Pancreatectomy with Roux-en-Y Pancreaticojejunostomy
Published on: November 20, 2021
Safe implementation of minimally invasive pancreas resection: a systematic review
Alma L Moekotte1, Arab Rawashdeh2, Horacio J Asbun3
1Department of Surgery, University Hospital of Southampton NHS Foundation Trust, Southampton, UK; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
Background:
Minimally invasive pancreas resection (MIPR) has been expanding in the past decade. Excellent outcomes have been reported, however, safety concerns exist. The aim of this study was to define prerequisites for performing MIPR with the objective to guide safe implementation of MIPR into clinical practice.
Methods:
This systematic review was conducted as part of the 2019 Miami International Evidence-Based Guidelines on Minimally Invasive Pancreas Resection (IG-MIPR). PubMed, Embase and Cochrane databases were searched for literature concerning the implementation of MIPR between 1946 and November 2018. Quality assessment was according to The Scottish Intercollegiate Guidelines Network (SIGN).
Results:
Overall, 1150 studies were screened, of which 32 studies with 8519 patients were included in this systematic review. Training programs for minimally invasive distal pancreatectomy, laparoscopic pancreatoduodenectomy and robotic pancreatoduodenectomy have been described with acceptable outcomes during the learning curve and improved outcomes after training. Learning curve studies have revealed an association between growing experience and improving perioperative outcomes. In addition, the association between higher center volume and lower mortality and morbidity has been reported by several studies.
Conclusion:
When embarking on MIPR, it is recommended to participate in a dedicated training program, to assure a sufficient volume, especially when implementing minimally invasive pancreatoduodenectomy, (20 procedures recommended annually), and prospectively collect and closely monitor outcomes for continuous quality assessment, this can be achieved through institutional databases and participation in national or international registries.
Insights
Implementing minimally invasive pancreas resection (MIPR) requires dedicated training and sufficient procedure volume. Continuous outcome monitoring is crucial for safe MIPR practice and improved patient results.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Evidence-Based Medicine
Background:
- Minimally invasive pancreas resection (MIPR) is increasingly adopted, with reported excellent outcomes.
- Safety concerns necessitate clear guidelines for safe implementation of MIPR.
Purpose of the Study:
- To define prerequisites for safe performance of MIPR.
- To guide the clinical implementation of MIPR.
Main Methods:
- Systematic review of literature from 1946 to November 2018.
- Searched PubMed, Embase, and Cochrane databases.
- Quality assessment using The Scottish Intercollegiate Guidelines Network (SIGN) criteria.
Main Results:
- 32 studies involving 8519 patients were included.
- Training programs show acceptable outcomes during learning curves, with improvement post-training.
- Higher center volume correlates with lower mortality and morbidity.
Conclusions:
- Participation in dedicated training programs is recommended for MIPR.
- A minimum annual volume of 20 procedures is suggested for minimally invasive pancreatoduodenectomy.
- Prospective outcome collection via databases and registries is vital for quality assessment.
