Robotic pancreaticoduodenectomy in patients with hepatic arterial variants: surgical outcomes and technical considerations in a single-center cohort

PURPOSE: Hepatic arterial anomalies are commonly encountered during pancreaticoduodenectomy. However, their impact on perioperative outcomes in robotic pancreaticoduodenectomy (RPD) remains unclear. METHODS: We retrospectively analyzed 79 consecutive patients who underwent RPD. Hepatic arterial anatomy was classified according to the systems of Michels and Hiatt. Perioperative outcomes were compared between patients with hepatic arterial variants and those with normal anatomy. RESULTS: Hepatic arterial anomalies were identified in 22 patients (27.8%). According to Hiatt's classification, 57 patients (72.2%) had normal type I anatomy, while type II and III variants were observed in 4 (5.1%) and 9 (11.4%) patients, respectively. Two patients exhibited type IV variants with both replaced right and left hepatic arteries. Data are presented in the order of absence and presence of arterial anomalies. Median age was similar (72 vs. 73 years, P = 0.86), with no difference in sex distribution (P = 0.25). Operative time (549 vs. 586 min, P = 0.92), blood loss (73 vs. 50 mL, P = 0.49), rates of clinically relevant postoperative pancreatic fistula (5.3% vs. 4.5%, P = 0.69), postoperative bleeding(0% vs. 4.5%, P = 0.27), pseudoaneurysm hemorrhage (5.3% vs. 0%, P = 0.55), and major complications (Clavien-Dindo grade ≥ 3a) (8.8% vs. 9.0%, P = 0.63) did not differ significantly. CONCLUSION: The presence of hepatic arterial anomalies did not adversely affect perioperative outcomes in patients undergoing RPD. These findings suggest that, with appropriate preoperative planning and meticulous surgical technique, RPD can be performed safely in selected patients with hepatic arterial variants at experienced centers.