# ASO Author Reflections: The Landmark Series: Minimally Invasive Pancreatic Resection—Past, Present, and Future

## TL;DR

Minimally invasive pancreatic surgery is becoming a safer option for some pancreatic cancer patients, but its widespread use depends on training, technology access, and cost reduction.

## Contribution

The paper highlights the current state and future directions of minimally invasive pancreatic resection, emphasizing the need for training and emerging technologies to improve accessibility.

## Key findings

- Randomized trials like DIPLOMA 2 × 2 and PORTAL are evaluating the role of minimally invasive techniques in pancreatoduodenectomy.
- Robotic assistance and augmented reality may reduce technical barriers and costs for minimally invasive pancreatic surgery.
- Training programs and institutional support are crucial for the safe adoption of minimally invasive pancreatic resection.

## Abstract

Minimally invasive pancreatic resection (MIPR) has emerged as a safe and effective approach for select patients with pancreatic ductal adenocarcinoma (PDAC), particularly for distal pancreatectomy. Ongoing randomized trials such as DIPLOMA 2 × 2 and PORTAL will further clarify its role in pancreatoduodenectomy, especially with robotic assistance. However, widespread adoption depends not only on evidence but also on access to technology and structured training programs. Expanding dedicated training, simulation-based education, and institutional support will be essential to ensure safe implementation. At the same time, emerging technologies such as augmented reality and next-generation robotics may help lower technical thresholds, lower prices, and accelerate adoption. The continued convergence of high-quality evidence, advanced surgical tools, and equitable implementation strategies will be critical to making MIPR a broadly accessible standard for PDAC, improving outcomes without compromising oncologic rigor. Barriers will need to be overcome to continue growth, such as limited availability of robotic platforms, high costs, and disparities in care.