Robotic pancreaticoduodenectomy: a structured narrative review of learning curve, patient selection, and program...

Pancreaticoduodenectomy remains among the most technically demanding abdominal operations because of complex vascular dissection, multiple reconstructions, and persistent risk of procedure-specific morbidity. Robotic pancreaticoduodenectomy (RPD) has been developed to extend minimally invasive surgery to pancreatic head and periampullary diseases, offering stable three-dimensional visualization, articulating instruments, and improved suturing ergonomics. However, technical feasibility alone does not establish broad clinical value. This structured narrative review maps current evidence on RPD across perioperative outcomes, oncologic safety, clinically relevant postoperative pancreatic fistula (CR-POPF), learning curve, reconstruction, complex cases, cost, and implementation readiness. Evidence was interpreted according to study design, center experience, outcome consistency, and clinical generalizability. Available data support the feasibility of RPD in selected patients treated by experienced teams and suggest possible reductions in blood loss, transfusion, and length of stay compared with open surgery. In contrast, evidence remains less mature for CR-POPF reduction, major morbidity, long-term oncologic outcomes, cost-effectiveness, and routine use in complex vascular or post-neoadjuvant cases. The clinical role of RPD should therefore be determined by alignment among patient complexity, pancreatic remnant risk, surgeon-team maturity, institutional volume, and rescue capacity. We propose an evidence-informed framework for staged implementation, patient selection, program readiness, and predefined conversion triggers. RPD should be viewed as a selective, team-dependent strategy rather than a universal replacement for open pancreaticoduodenectomy.