Safety and short‑term efficacy of robotic‑assisted total pancreatectomy

Objective To investigate the safety and short‑term efficacy of robotic‑assisted total pancreatectomy (RTP).

Methods The retrospective and descriptive study was conducted. The clinicopathological data of 9 patients who underwent RTP at The First Affiliated Hospital of Sun Yat‑sen University from January 2020 to December 2025 were collected. There were 6 males and 3 females, aged 63(20) years. Observation indicators: (1) intraoperative conditions; (2) postoperative patholo-gical examination results; (3) postoperative recovery; (4) introduction of a typical case. Measurement data with skewed distribution were represented as M(IQR), and count data were expressed as absolute numbers.

Results (1) Intraoperative conditions: all 9 patients underwent RTP successfully, without conversion to open surgery. The operation time of 9 patients was 670(270) minutes, and the volume of intraoperative blood loss was 100(175) mL. Four of the 9 patients required intraoperative red blood cell transfusion. Of the 9 patients, 6 cases underwent splenectomy during the operation, while the other 3 patients had spleen preserved, including 2 cases with the Warshaw method and 1 case with the Kimura method for spleen preservation. (2) Postoperative pathological examination results: all 9 patients achieved R₀ resection, with the number of lymph node dissected as 18(15). Of the 9 patients, there were 4 cases of pancreatic ductal adenocarcinoma, 2 cases of intraductal papillary mucinous neoplasm, 1 case of intraductal papillary mucinous neoplasm with carcinogenesis (carcinoma in situ), 1 case of von Hippel‑Lindau syndrome with pancreatic neuroendocrine neoplasm, and 1 case of mixed neuroendocrine‑non‑neuroendocrine neoplasm. (3) Postoperative recovery: the duration of postoperative hospital stay of 9 patients was 13(11) days. Of the 9 patients, 2 cases developed Clavien‑Dindo grade Ⅲa complications postoperatively, both of which were delayed gastric emptying. The 2 patients were improved after undergoing endoscopic jejunal feeding tube placement. One patient developed chylous leakage postoperatively, and was improved after conservative treatment. None of the 9 patients experienced postoperative bleeding, biliary fistula, or reoperation during the perioperative period. No patient died within 30 days after surgery, and no patient was readmitted within 30 days after discharge. (4) Introduction of a typical case: one patient had von Hippel‑Lindau syndrome complicated with pancreatic neuroendocrine neoplasm, the preoperative computed tomo-graphy scan of whom showed neuroendocrine neoplasm in the pancreatic head combined with multiple cystic lesions in the pancreatic body and tail. Preoperatively, the patient suffered from upper gastrointestinal bleeding due to the giant neuroendocrine neoplasm in the pancreatic head protruding into the duodenal lumen and rupturing, while the tumor also compressing the common bile duct, leading to obstructive jaundice. The patient successfully underwent RTP.

Conclusions RTP should be performed by physicians with extensive experience in robotic pancreatic surgery to ensure good surgical safety and short‑term efficacy.