Robotic pancreatoduodenectomy: Technical details and results of 178 operations

Introduction . Pancreatoduodenectomy remains one of the most challenging procedures in abdominal surgery due to its technical complexity and high complication rate. Robotic pancreatoduodenectomy (RPD) is a minimally invasive approach that provides enhanced precision and visualization. This study describes the surgical technique and evaluates outcomes of RPD performed at the S.P. Botkin Moscow Multidisciplinary Scientific and Clinical Center. The aim of the study is to evaluate safety of RPD in treatment of tumors of the head of the pancreas, major duodenal papilla, and distal part of the common bile duct, and to provide detailed description of the technique. Materials and methods . A retrospective analysis of 178 RPDs performed between January 2013 and October 2025 at the S.P. Botkin Moscow Multidisciplinary Scientific and Clinical Center of the Moscow Healthcare Department was conducted. All procedures were performed using the da Vinci Si/Xi robotic surgical systems. Complications were graded according to the Clavien—Dindo classification, and pancreas-specific complications were assessed using the International Study Group on Pancreatic Surgery (ISGPS) definitions. Results . Mean operative time was 357 ± 7.1 min; mean blood loss was 174 ± 55 mL; conversion rate was 2.8 % ( n = 5). Major complications (Clavien—Dindo grades III-V) occurred in 19.7 % ( n = 35) of patients. Postoperative pancreatic fistula developed in 66.8 % of patients, postpancreatectomy hemorrhage in 7.3 %, and gastroparesis in 6.2 %. Mortality was 2.8 % ( n = 5). Conclusion . RPD is feasible and safe in experienced hands, with an acceptable complication profile comparable to open and laparoscopic techniques. It is associated with reduced blood loss and has potential to improve oncological outcomes. Further randomized studies are needed to confirm its long-term benefits.