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Updated: Aug 5, 2025
Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head
Published on: January 3, 2020
Minimally-invasive versus open pancreatic enucleation: systematic review and metanalysis of short-term outcomes
Raffaello Roesel1, Lorenzo Bernardi2, Marco A Bonino1
1Department of Visceral Surgery, University Hospital of Geneva (HUG), Rue Gabrielle-Perret Gentil 4, Geneve, Switzerland.
Background:
Minimally Invasive Pancreatic Enucleation, either laparoscopic or robot-assisted, is rarely performed. The aim of this study was to offer the current available evidence about the outcomes of minimally invasive pancreatic enucleations and explore the possible advantage of this approach over traditional surgery.
Methods:
PubMed (MEDLINE), Cochrane Library and Embase (ELSEVIER) medical databases were searched for articles published from January 1990 to March 2022. Studies which included more than 10 cases of minimally-invasive pancreatic enucleation were included. Data on the outcomes were synthetized and meta-analyzed when appropriate.
Results:
Twenty studies published between 2009 and 2022 with a total of 552 patients were included in the systematic review: three hundred fifty-one patients (63.5%) had a laparoscopic intervention, two hundred and one (36.5%) robot-assisted with a cumulative incidence of conversion rate of 5%. Minimally-invasive surgery was performed in 63% of cases on the body/tail of the Pancreas and in 37% of the cases on the head/uncinate process of the Pancreas. The cumulative post-operative 30 days - mortality rate was 0.2% and the major postoperative morbidity (Clavien-Dindo III-IV-V) 35%. Clinically relevant pancreatic fistula was observed in 17% of the patients. Compared with the standardized open approach (n: 366 patients), mean length of hospital stay was significantly reduced in patients undergoing minimally invasive pancreatic enucleation (2.45 days, p = 0.003) with a favorable trend for post-operative major morbidity (Clavien-Dindo III-IV) (- 24% RR, p: 0.13). Operative time, blood loss and clinically relevant pancreatic fistula rate were comparable between the two groups. One hundred and fourteen robot-assisted enucleations entered in a subgroup analysis with comparable results to open surgery.
Conclusion:
Minimally-Invasive approach for pancreatic enucleation is safe, feasible and offers short-term clinical outcomes comparable with open surgery. The potential benefit of robotic surgery will need to be verified in further studies.
Insights
Minimally invasive pancreatic enucleation, using laparoscopic or robotic techniques, demonstrates safe and feasible outcomes comparable to open surgery. This approach significantly reduces hospital stay, with potential benefits for major morbidity needing further investigation.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Pancreatic enucleation is a complex procedure, with minimally invasive approaches (laparoscopic and robot-assisted) being infrequently performed.
- This study systematically reviews current evidence on the outcomes of minimally invasive pancreatic enucleation versus traditional open surgery.
Approach:
- A comprehensive search of PubMed, Cochrane Library, and Embase databases was conducted for studies published between January 1990 and March 2022.
- Studies with over 10 cases of minimally invasive pancreatic enucleation were included, with data synthesized and meta-analyzed where appropriate.
Key Points:
- Twenty studies (552 patients) showed minimally invasive pancreatic enucleation (63.5% laparoscopic, 36.5% robot-assisted) had a 5% conversion rate.
- Compared to open surgery (366 patients), minimally invasive approaches significantly reduced hospital stay (2.45 days, p=0.003) with comparable operative time, blood loss, and fistula rates.
- Postoperative mortality was 0.2%, major morbidity (Clavien-Dindo III-V) was 35%, and clinically relevant pancreatic fistula occurred in 17% of patients.
Conclusions:
- Minimally invasive pancreatic enucleation is a safe and feasible surgical option.
- Short-term clinical outcomes are comparable to open surgery, with a notable reduction in hospital stay.
- Further research is warranted to fully elucidate the potential advantages of robotic-assisted pancreatic enucleation.
