Robotic Parenchymal-Sparing Pancreatectomy: A Systematic Review

SIMPLE SUMMARY: Non-anatomic pancreatic resections such as enucleation, duodenum-preserving partial pancreatic head resection, central pancreatectomy, and uncinate resection allow for the preservation of more pancreatic parenchyma than standard resections, i.e., Whipple and distal pancreatectomy. These lead to a significantly lesser degree of endocrine and exocrine insufficiency. Robotic approaches are increasingly being adopted for these technically challenging parenchymal-sparing procedures. The aim of our study was to evaluate the use and added value of the robotic approach compared to open approaches and standard anatomic resections. We carried out a systematic review of the available literature surrounding robotic parenchymal-sparing pancreatectomy and found that while postoperative pancreatic fistula remains common, severe complications are exceedingly rare, and rates of endocrine and exocrine insufficiency are negligible after these procedures. ABSTRACT: Background: Parenchymal-sparing approaches to pancreatectomy are technically challenging procedures but allow for preserving a normal pancreas and decreasing the rate of postoperative pancreatic insufficiency. The robotic platform is increasingly being used for these procedures. We sought to evaluate robotic parenchymal-sparing pancreatectomy and assess its complication profile and efficacy. Methods: This systematic review consisted of all studies on robotic parenchymal-sparing pancreatectomy (central pancreatectomy, duodenum-preserving partial pancreatic head resection, enucleation, and uncinate resection) published between January 2001 and December 2022 in PubMed and Embase. Results: A total of 23 studies were included in this review (n = 788). Robotic parenchymal-sparing pancreatectomy is being performed worldwide for benign or indolent pancreatic lesions. When compared to the open approach, robotic parenchymal-sparing pancreatectomies led to a longer average operative time, shorter length of stay, and higher estimated intraoperative blood loss. Postoperative pancreatic fistula is common, but severe complications requiring intervention are exceedingly rare. Long-term complications such as endocrine and exocrine insufficiency are nearly nonexistent. Conclusions: Robotic parenchymal-sparing pancreatectomy appears to have a higher risk of postoperative pancreatic fistula but is rarely associated with severe or long-term complications. Careful patient selection is required to maximize benefits and minimize morbidity.