Robotic pancreatoduodenectomy

Pancreatoduodenectomy (PD) is a challenging surgery that, despite many technical advances, still has a relevant morbidity and mortality. Robotic approach could offer many advantages. This chapter aimed to provide an overview of evidence about robotic PD. We performed a systematic literature search using the PubMed database to identify systematic reviews about robotic PD. Morbidity, mortality, and oncologic outcomes in robotic PD are comparable or a little better than in open or laparoscopic approaches, although operative time is often longer. Studies about cost-effectiveness are lacking. Regarding the learning curve, 20 PDs seem to be the minimum recommended volume per year, but training programs are essential for its safe implementation. Further research is needed to clarify the best surgical technique. Robotic PD seem to be not contraindicated in elderly or obese patients. Robotic PD should be performed in selected patients at experienced centers. Further research is needed to better define its role.