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. 2025 Sep 22;14(18):6687.
doi: 10.3390/jcm14186687.

Textbook Outcomes of Totally Robotic Versus Totally Laparoscopic Pancreaticoduodenectomy for Periampullary Neoplasm: A Propensity Score-Matched Cohort Study

Boram Lee  1 , Ho-Seong Han  1 , Yoo-Seok Yoon  1 , Jun Suh Lee  1
Affiliations

Textbook Outcomes of Totally Robotic Versus Totally Laparoscopic Pancreaticoduodenectomy for Periampullary Neoplasm: A Propensity Score-Matched Cohort Study

Boram Lee et al. J Clin Med. .

Abstract

Background/Objectives: Textbook outcome (TO) is a composite quality measure in surgery, but few studies have compared TO between robotic pancreaticoduodenectomy (RPD) and laparoscopic pancreaticoduodenectomy (LPD). This study aimed to evaluate and compare TO following RPD and LPD for periampullary neoplasms. Methods: We retrospectively analyzed 322 patients who underwent minimally invasive PD between 2010 and 2023 (RPD, n = 60; LPD, n = 262). LPD was first introduced in 2004, but only cases performed since 2010 were included, while RPD has been performed since 2019. Propensity score matching (1:2) yielded 48 RPD and 96 LPD patients. TO was defined as the absence of pancreatic fistula, bile leak, post-pancreatectomy hemorrhage, severe complications (Clavien-Dindo ≥ III), readmission, and in-hospital or 30-day mortality. Results: In the entire cohort, 240 of 322 patients (74.5%) achieved TO. After matching, TO rates were 64.6% in RPD and 76.9% in LPD (p = 0.656). Perioperative outcomes, including operative time, blood loss, transfusion, hospital stay, and major complications, were comparable, although RPD showed a higher incidence of hemorrhage (p = 0.032). Multivariate analysis identified body mass index < 25 kg/m2 as an independent predictor of achieving TO (OR 3.13, p = 0.008). Conclusions: RPD and LPD achieved comparable textbook outcomes in periampullary surgery. Both approaches are feasible when performed by experienced surgeons, but larger studies with long-term follow-up are needed to validate these findings.

Keywords: laparoscopy; minimally invasive surgical procedures; pancreaticoduodenectomy; periampullary neoplasms; robotic surgical procedures.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Trocar placement for robotic and laparoscopic pancreaticoduodenectomy. (a) Robotic pancreaticoduodenectomy: trocar positions include the scope port (S) centrally, robotic arms (R1, R2, R3) laterally, and an assistant port (A) on the patient’s left side. (b) Laparoscopic pancreaticoduodenectomy: trocar positions include three 12 mm ports for instruments (blue circles) and two 5 mm ports for additional instruments (orange circles), arranged around the surgical site.
Figure 2
Figure 2
Comparison of textbook outcomes between laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD).
See this image and copyright information in PMC

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