The British technique of purely robotic Whipple's pancreatoduodenectomy a systematic and stepwise ('clockwise')...

The growing trend towards minimally invasive hepato-biliary and pancreatic (HPB) surgery has led to the evolution of multiple techniques in the performance of the pancreaticoduodenectomy (PD), either Whipple's procedure or pylorus-preserving pancreaticoduodenectomy (PPPD), for lesions in the head of the pancreas and other indications. Recent trials have highlighted the limitations of the laparoscopic technique when it comes to PD. The use of robotic assistance allows surgeons to circumvent these limitations and carry out robotic pancreaticoduodenectomy (RPD) with good outcomes. The technique described has been adopted and practiced in multiple UK HPB centres and is based on a collective experience of performing over 200 purely robotic PDs. The technique has been implemented in over 20 robotic HPB centers across the UK and Europe and has been widely adopted as the go-to technique in the implementation of RPD. The method is described as distinct steps to allow for a systematic stepwise approach to the procedure. This technique is particularly suitable for all cases where there is no risk of vascular involvement, as confirmed by a preoperative scan conducted two weeks prior to surgery, especially in malignant conditions. A video description of all the steps is included with the publication. The method described has been adopted successfully in HPB programs across the UK and some European centers, with some variations according to local preferences. A separate article is being constructed with the data on short and long-term outcomes being collated across the UK centers in a prospective manner. This paper is to share the British technique of purely robotic PD.