Robotic pancreatoduodenectomy: trends in technique and training challenges

Background More complex cases are being performed robotically. This study aims to characterize trends in robotic pancreatoduodenectomy (RPD) over time and assess opportunities for advanced trainees. Methods Using the ACS-NSQIP database from 2014 to 2019, PD cases were characterized by operative approach (open-OPN, laparoscopic-LAP, robotic-ROB). Proficiency and postoperative outcomes were described by approach over time. Results 24,268 PDs were identified, with the ROB approach increasing from 2.8% to 7.5%. Unplanned conversion increased over time for LAP (27.7–39.0%, p = 0.003) but was unchanged for ROB cases (14.8–14.7%, p = 0.257). Morbidity increased for OPN PD (35.5–36.8%, p = 0.041) and decreased for ROB PD (38.7–30.3%, p = 0.010). Mean LOS was lower in ROB than LAP/OPN (9.5 vs. 10.9 vs. 10.9 days, p