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Updated: Sep 13, 2025

Robot Assisted Distal Pancreatectomy with Celiac Axis Resection DP-CAR for Pancreatic Cancer: Surgical Planning and Technique
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Robotic Versus Hand-Assisted Distal Pancreatectomy: A Comparative Single Center Retrospective Study.

Nabih Essami1,2, Esther Kazlow1,2, Eitan Dines1,2

  • 1Technion Israel Institute of Technology, Rappaport Faculty of Medicine, Haifa 3109601, Israel.

Journal of Clinical Medicine
|July 29, 2025
PubMed
Summary

Robotic-assisted distal pancreatectomy (RDP) shows promise over hand-assisted laparoscopic distal pancreatectomy (HALDP), offering shorter hospital stays and fewer severe complications. While operative times are longer, RDP may improve patient outcomes in pancreatic lesion treatment.

Keywords:
hand-assisted laparoscopic surgerypancreatectomypostoperative outcomesrobotic surgeryrobotic-assisted distal pancreatectomy

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Area of Science:

  • Minimally Invasive Surgery
  • Surgical Oncology
  • Gastrointestinal Surgery

Background:

  • Limited direct comparisons exist between robotic-assisted distal pancreatectomy (RDP) and hand-assisted laparoscopic distal pancreatectomy (HALDP).
  • Distal pancreatectomy is a key surgical procedure for pancreatic lesions.
  • Existing literature extensively covers open, laparoscopic, and RDP, but lacks specific HALDP vs. RDP data.

Purpose of the Study:

  • To compare the safety and efficacy of RDP versus HALDP for treating pancreatic lesions.
  • To evaluate peri-operative parameters and 90-day morbidity and mortality between the two surgical techniques.

Main Methods:

  • Retrospective review of 97 distal pancreatectomy patients (2008-2024) at Carmel Medical Center.
  • Final cohort of 57 patients: 20 RDP and 37 HALDP, excluding open and pure laparoscopic resections.
  • Analysis of primary peri-operative outcomes and secondary 90-day morbidity/mortality.

Main Results:

  • RDP had significantly longer operative times (3.9 vs. 2.5 h, p < 0.001) but shorter hospital stays (4.7 vs. 5.8 days, p = 0.02).
  • RDP demonstrated superior lymph node retrieval (11 vs. 5.4, p = 0.01) and no severe morbidity (Clavien-Dindo ≥ IIIa), unlike HALDP (8%, p = 0.04).
  • Pancreatic fistula rates were numerically higher in RDP (35% vs. 16.2%, p = 0.18), but overall complication rates were comparable (55% vs. 43.2%, p = 0.39); no 90-day mortality in either group.

Conclusions:

  • RDP may offer advantages over HALDP, including shorter hospital stays and reduced severe postoperative morbidity, despite longer operative times.
  • RDP facilitates better lymph node retrieval, a critical factor in oncological resections.
  • Larger prospective studies are warranted to confirm these findings and establish optimal surgical approaches for distal pancreatectomy.