Robotic Versus Hand-Assisted Distal Pancreatectomy: A Comparative Single Center Retrospective Study

Abstract

Background: While there is an abundance of comparative studies on open, laparoscopic, and robotic-assisted distal pancreatectomies (RDPs) available in the literature, direct comparisons between RDP and hand-assisted laparoscopic distal pancreatectomy (HALDP) are limited. This study aimed to assess the safety and efficacy of RDPs in comparison to HALDPs in the treatment of pancreatic lesions. Methods: This study reviewed 97 patients who underwent distal pancreatectomy at Carmel Medical Center between 2008 and 2024. After excluding 40 patients (24 open and 16 pure laparoscopic resections), the final cohort comprised 57 patients: 20 RDPs and 37 HALDPs. The primary outcomes included peri-operative parameters, while secondary outcomes encompassed 90-day morbidity and mortality. Results: RDPs led to significantly longer operative times (3.9 vs. 2.5 h, p < 0.001) but resulted in shorter hospital stays (4.7 vs. 5.8 days, p = 0.02) and a higher number of harvested lymph nodes (11 vs. 5.4, p = 0.01). While clinically significant pancreatic fistula rates were numerically higher in the RDP group (35% vs. 16.2%, p = 0.18), this difference was not statistically significant. Overall, complication rates were comparable (55% vs. 43.2%, p = 0.39). Severe morbidity (Clavien-Dindo ≥ IIIa) was absent in the RDP group compared to 8% in the HALDP group (p = 0.04). No 90-day mortality was observed in either group. Conclusions: This study indicates that although RDP involves longer operative times, it may provide certain advantages for patients, such as shorter hospital stays, better lymph node retrieval, and a notable decrease in postoperative morbidity when compared to HALDP. Larger prospective studies are needed to validate these results and to determine the most effective surgical approach for distal pancreatectomy.

Keywords: hand-assisted laparoscopic surgery; pancreatectomy; postoperative outcomes; robotic surgery; robotic-assisted distal pancreatectomy.

Figure 1

Operation time.

Figure 2

Length of hospital stay.

Figure 3

Number of harvested lymph nodes.