Related Experiment Video
Updated: Sep 16, 2025
Robotic Spleen-Preserving Distal Pancreatectomy: The Warshaw and Kimura Techniques
Published on: July 26, 2024
Minimally Invasive Spleen-Preserving Distal Pancreatectomy in Obese Patients: Factors Related to Clinically Relevant
Fabio Ausania1, Filippo Landi1, Carolina González-Abós1
1Department of HBP Surgery and Transplantation, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain.
Background:
Minimally invasive spleen-preserving distal pancreatectomy (MI-SPDP) provides superior outcomes compared with open surgery, with robotic techniques showing better short-term results than laparoscopic techniques, particularly in obese patients. This study aimed to evaluate the impact of the surgical approach on postoperative pancreatic fistula (POPF) incidence in obese patients undergoing MI-SPDP.
Methods:
A retrospective analysis of obese patients from 16 international centres compared robotic (R-SPDP) and laparoscopic (L-SPDP) approaches. Perioperative outcomes and factors associated with clinically relevant POPF were analysed using univariate and multivariate methods.
Results:
Among 130 patients (57L-SPDP, 73R-SPDP), POPF incidence was significantly lower in the robotic group (15.1% vs. 42.1%; p = 0.001). The Comprehensive Complications Index was also lower (8% vs. 15%; p = 0.002). Laparoscopic approach (OR = 4.0), pancreatic body transection (OR = 2.6), and non-stapler stump closure (OR = 3.2) were independently associated with higher POPF rates.
Discussion:
Robotic MI-SPDP reduces POPF in obese patients. Transection at the pancreatic neck and stapler-based closure can improve outcomes.
