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Updated: May 14, 2026
Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head
Published on: January 3, 2020
Safety and Efficiency of Various Pancreatic Enucleation Procedures: A Systematic Review and Meta-Analysis
Deqiang Zhou1, Feng Tan1, Zihe Wang1
1Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China.
Abstract:
Objective: This study aimed to systematically compare the short-term outcomes of minimally invasive pancreatic enucleation (MI-pEn), including laparoscopic and robotic-assisted approaches, and open pancreatic enucleation (O-pEn). Methods: A systematic search of PubMed, MEDLINE, Embase, and Web of Science was conducted for studies published between January 1990 and December 2025 that compared various types of pancreatic enucleation. The literature screening, data extraction, and quality assessment followed the PRISMA guidelines. The meta-analysis was performed using RevMan 5.4.1 and R 4.3.0. Results: Fifteen studies were included, with thirteen comparative studies (463 MI-pEn, 547 O-pEn) incorporated into the meta-analysis. Two studies comparing laparoscopic and robot-assisted enucleation were also included. No significant difference in clinically relevant postoperative pancreatic fistula (CR-POPF) was detected between MI-pEn and O-pEn (OR = 0.78; 95% CI: 0.56-1.07; p = 0.12). However, MI-pEn was associated with significantly reduced operation time (MD = -21.24; p = 0.01), blood loss (MD = -75.88; p < 0.00001), hospital stay (MD = -2.07; p = 0.001), and wound infection (OR = 0.3; p = 0.03). Direct comparisons between robotic and laparoscopic enucleation revealed no significant differences in any outcomes. Conclusions: MI-pEn is safe and feasible and offers advantages in terms of operative time, blood loss, and recovery without increasing complications. Robotic and laparoscopic approaches yield comparable short-term outcomes in pancreatic enucleation, although the potential advantage of robotic surgery in reducing pancreatic fistula risk warrants further validation.
Insights
Minimally invasive pancreatic enucleation (MI-pEn) offers reduced operation time, blood loss, and hospital stay compared to open surgery, without increasing complications. Robotic and laparoscopic approaches show similar short-term outcomes for pancreatic enucleation.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Pancreatic enucleation is a key procedure for benign or borderline malignant pancreatic neoplasms.
- Minimally invasive pancreatic enucleation (MI-pEn), encompassing laparoscopic and robotic approaches, is increasingly adopted.
- Direct comparisons of short-term outcomes between MI-pEn and open pancreatic enucleation (O-pEn) are crucial for clinical decision-making.
Purpose of the Study:
- To systematically compare the short-term outcomes of minimally invasive pancreatic enucleation (MI-pEn) versus open pancreatic enucleation (O-pEn).
- To evaluate the comparative effectiveness of laparoscopic versus robotic-assisted pancreatic enucleation.
Main Methods:
- Systematic literature search of PubMed, MEDLINE, Embase, and Web of Science (1990-2025).
- Meta-analysis of 13 comparative studies (463 MI-pEn, 547 O-pEn) following PRISMA guidelines.
- Utilized RevMan 5.4.1 and R 4.3.0 for statistical analysis.
Main Results:
- No significant difference in clinically relevant postoperative pancreatic fistula (CR-POPF) between MI-pEn and O-pEn (OR = 0.78; p = 0.12).
- MI-pEn demonstrated significantly reduced operation time (p = 0.01), blood loss (p < 0.00001), hospital stay (p = 0.001), and wound infection (p = 0.03).
- Laparoscopic and robotic enucleation showed comparable short-term outcomes.
Conclusions:
- Minimally invasive pancreatic enucleation is safe, feasible, and offers significant advantages in operative efficiency and patient recovery.
- MI-pEn does not increase postoperative complications compared to open procedures.
- Robotic and laparoscopic pancreatic enucleation yield similar short-term results, with further research needed on robotic surgery's potential CR-POPF benefits.
