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Total laparoscopic versus robotic-assisted laparoscopic pancreaticoduodenectomy: which one is better?



Minimally invasive pancreaticoduodenectomy (MIPD) is a challenging procedure. Laparoscopic pancreaticoduodenectomy (LPD) is feasible and safe. Since the development of robotic platforms, the number of reports on robot-assisted pancreatic surgery has increased. We compared the technical feasibility and safety between LPD and robot-assisted LPD (RALPD).


From September 2012 to August 2020, 257 patients who underwent MIPD for periampullary tumors were enrolled. Of these, 207 underwent LPD and 50 underwent RALPD. We performed a 1:1 propensity score-matched (PSM) analysis and retrospectively analyzed the demographics and surgical outcomes.


After PSM analysis, no difference was noted in demographics. Operation times and estimated blood loss were similar, as was the incidence of complications (p > 0.05). In subgroup analysis in patients with soft pancreas with pancreatic duct ≤ 2 mm, no significant between-group difference was noted regarding short-term surgical outcomes, including clinically relevant POPF (CR-POPF) (p > 0.05). In multivariable analysis, the only soft pancreatic texture was a predictive factor (HR 3.887, 95% confidence interval 1.121–13.480, p = 0.032).


RALPD and LPD are safe and effective for MIPD and can compensate each other to achieve the goal of minimally invasive surgery.

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Munseok Choi acquired and analyzed the data and drafted the manuscript. Ho Kyoung Hwang, Seoung Yoon Rho and Sung Hyun Kim revised the manuscript. Woo Jung Lee provided revision fo the article for important intellectual content. Chang Moo Kang conceived and designed the study, revised, and gave final approval to the manuscript.

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Correspondence to Chang Moo Kang.

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Drs. Munseok Choi, Seoung Yoon Rho, Sung Hyun Kim, Ho Kyoung Hwang, Woo Jung Lee, Chang Moo Kang have no conflicts of interest or financial ties to disclose.

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Choi, M., Rho, S.Y., Kim, S.H. et al. Total laparoscopic versus robotic-assisted laparoscopic pancreaticoduodenectomy: which one is better?. Surg Endosc (2022).

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  • Pancreaticoduodenectomy
  • Pancreatic fistula
  • Pancreaticojejunostomy
  • Pancreatic duct