A Comparision of Short-Term Surgical Outcomes Between Laparoscopic Vs. Robotic Whipple's Pancreaticoduodenectomy

The safety of a minimally invasive pancreaticoduodenectomy has gained increasing support in literature compared to open procedures. However, there is dearth of comparative studies focusing on laparoscopic versus robotic pancreaticoduodenectomy. This study seeks to compare the rates of pancreatic fistulas and overall complications occurring within 30 days postoperatively between these two surgical approaches. The study encompassed assessment of data of patients who underwent laparoscopic and robotic pancreaticoduodenectomy between 2020 and 2023 at GEM hospital Coimbatore and GEM Hospital Chennai. Patients were assessed for any potential relationship between the type of minimally invasive approach and 30-day overall complications. Statistical analysis was done. We identified 102 minimally invasive pancreaticoduodenectomy cases, of which 51 (50%) were performed laparoscopically and 51 (50%) robotically. The present analysis did not reveal any significant differences in laparoscopy/open conversion (L-9.8% vs. R-5.88%), mean blood loss, (L-256.69 ml vs. R-282.61 ml), no. of lymph nodes retrieved (L-10.2 vs. R-10.75), length of hospital stay (L-11.9 vs. R-13.1 days), duration for resumption of oral diet (L-4.75 vs. R-4.1 days), complications like CR-POPF (L-11.76% vs. R-15.72%), POPH (L-15.72%, R-11.76%), SSI (L-17.64%, R-15.68%), bile leak (L-5.8%, R-5.8%), re-exploration (L-3 vs. R-1 patient), and death (1 in each group). Operative times were significantly higher in the robotic pancreaticoduodenectomy (PD) (L-415.29 vs. R-503 min; p value = 0.001). Type of the minimally invasive approach (laparoscopic/robotic) was not associated with overall complications. The robotic pancreaticoduodenectomy (RPD) is a feasible and safe procedure in appropriately selected patients. RPD could be a viable alternative to the standard laparoscopic procedure. RPD though requires longer operative periods has similar short-term postoperative outcomes when compared to the laparoscopic pancreaticoduodenectomy (LPD). This study suggests that both minimally invasive approaches have similar outcomes with regard to pancreatic fistula and other postoperative complications and oncological adequacy of resection.