Technical considerations for the fully robotic pancreaticoduodenectomy

Minimally invasive surgery, including robotic surgery, has become the standard of care for many abdominal procedures. However, the technical complexity associated with pancreaticoduodenectomy (PD) due to the anatomic location and oncologic characteristics of pancreatic tumors has hindered the widespread application of minimally invasive techniques to this procedure. Recent studies have reported that for experienced surgeons, the application of robotic techniques to PD is associated with equivalent oncologic outcomes and rates of complication when compared to an open operation, and may be associated with accelerated surgical recovery. Despite these encouraging results, robotic PD (RPD) is a procedure attempted by a small group of pancreatic surgeons, leading to the great heterogeneity in the techniques used to perform this operation. Herein we describe our technique for fully RPD and demonstrate its execution with a video supplement.