title: Total robotic pancreaticoduodenectomy: a systematic review of the literature.
abstract: Pancreaticoduodenectomy (PD) is a complex operation with high perioperative morbidity and mortality, even in the highest volume centers. Since the development of the robotic platform, the number of reports on robotic-assisted pancreatic surgery has been on the rise. This article reviews the current state of completely robotic PD.
  
  
  
  A systematic literature search was performed including studies published between January 2000 and July 2016 reporting PDs in which all procedural steps (dissection, resection and reconstruction) were performed robotically.
  
  
  
  Thirteen studies met the inclusion criteria, including a total of 738 patients. Data regarding perioperative outcomes such as operative time, blood loss, mortality, morbidity, conversion and oncologic outcomes were analyzed. No major differences were observed in mortality, morbidity and oncologic parameters, between robotic and non-robotic approaches. However, operative time was longer in robotic PD, whereas the estimated blood loss was lower. The conversion rate to laparotomy was 6.5-7.8%.
  
  
  
  Robotic PD is feasible and safe in high-volume institutions, where surgeons are experienced and medical staff are appropriately trained. Randomized controlled trials are required to further investigate outcomes of robotic PD. Additionally, cost analysis and data on long-term oncologic outcomes are needed to evaluate cost-effectiveness of the robotic approach in comparison with the open technique.
authors.affiliation: 1st Department of Surgery, "G. Genimatas" General Hospital, Athens, Greece.
authors.forename: Michail
authors.initials: M
authors.lastname: Kornaropoulos
authors.affiliation: Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave., NE60, Cleveland, OH, 44195, USA. dimmoris@yahoo.com.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Moris
authors.affiliation: Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
authors.forename: Eliza W
authors.initials: EW
authors.lastname: Beal
authors.affiliation: 1st Department of Surgery, "G. Genimatas" General Hospital, Athens, Greece.
authors.forename: Marinos C
authors.initials: MC
authors.lastname: Makris
authors.affiliation: 1st Department of Surgery, "G. Genimatas" General Hospital, Athens, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Mitrousias
authors.affiliation: Hepatobiliary and Surgical Oncology Department, Nicosia Teaching Hospital, Nicosia, Cyprus.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Petrou
authors.affiliation: 1st Department of Surgery, Laikon General Hospital, Athens, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Felekouras
authors.affiliation: 1st Department of Surgery, Laikon General Hospital, Athens, Greece.
authors.forename: Adamantios
authors.initials: A
authors.lastname: Michalinos
authors.affiliation: 1st Department of Surgery, Laikon General Hospital, Athens, Greece.
authors.forename: Michail
authors.initials: M
authors.lastname: Vailas
authors.affiliation: 1st Department of Surgery, Laikon General Hospital, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Schizas
authors.affiliation: 1st Department of Surgery, Laikon General Hospital, Athens, Greece.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Papalampros
mesh_terms: D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D061646:Operative Time; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D012371:Robotics
keywords: Da Vinci; Minimally invasive; Open; Pancreatic surgery; Pancreaticoduodenectomy; Robotic; Robotics; Whipple procedure