# Initial Experience of a Series of Single-Port Robotic Pancreatoduodenectomy Using the Da Vinci SP System

## TL;DR

This paper presents the early results of a new robotic surgery method for pancreatoduodenectomy, showing it is technically feasible with acceptable short-term outcomes.

## Contribution

The study introduces a standardized step-by-step procedure for single-port robotic-assisted pancreatoduodenectomy using the da Vinci SP system.

## Key findings

- Seven patients underwent the procedure with no need for conversion to open or laparoscopic surgery.
- Postoperative complications occurred in 57.1% of patients, but no 30- or 90-day mortality was observed.
- R0 resection was achieved in 85.7% of patients, demonstrating the technique's potential for oncological outcomes.

## Abstract

Objective: This study reports the initial series of patients who underwent single-port robotic-assisted pancreatoduodenectomy (SPRPD) using the da Vinci SP system (Intuitive Surgical, Inc., Sunnyvale, CA), demonstrating its technical feasibility and short-term perioperative outcomes. We also aimed to provide a standardized step-by-step SPRPD procedure to facilitate the learning curve.

Methods: We analyzed clinical data, surgical steps, and postoperative recovery of patients who underwent SPRPD between August 2024 and December 2024. Short-term outcomes were assessed.

Results: Seven patients underwent SPRPD using the da Vinci SP system. Fourteen operative steps were summarized as key elements of the SPRPD procedure. The average age was 68 years, with five males and two females. Diagnoses included pancreatic head adenocarcinoma (three cases), duodenal adenocarcinoma (two cases), common bile duct adenocarcinoma (one case), and intraductal papillary mucinous neoplasm (IPMN, low grade) (one case). The average single-arm docking time was 3.5 minutes. The mean operative time was 584 minutes (9.7 hours), with an estimated blood loss of 143 ml; only one patient required a blood transfusion. No patient required conversion to laparoscopic or open surgery. Regarding short-term oncological outcomes, the largest tumor measured 2.7 cm, and the average number of harvested lymph nodes was 12. A clear resection margin (R0) was achieved in six patients (85.7%), whereas one patient with pancreatic head cancer had a positive superior mesenteric vein margin (14.3%). Delicate surgical anatomical dissection and all types of pancreato-biliary-enteral reconstruction were successfully performed. Postoperative complications included clinically relevant postoperative pancreatic fistula (CR-POPF, grade B) in one patient (14.3%) and delayed gastric emptying in two patients (28.6%). Major complications (Clavien-Dindo grade ≥ III) occurred in four patients (57.1%). There was no 30- or 90-day mortality. Patients resumed oral intake after a mean of 9.2 days, with an average postoperative hospital stay of 22.2 days. Two patients (28.6%) were readmitted because of delayed gastric emptying and vomiting.

Conclusions: SPRPD is technically feasible with favorable short-term outcomes. This approach facilitates precise anatomical dissection with negative margins and allows the execution of all types of anastomoses. However, the adoption of SPRPD as a standard approach remains controversial. Long-term outcomes and randomized controlled trials are necessary to define the role of SPRPD more clearly. Standardized operative techniques may shorten the learning curve.