Robotic vs. laparoscopic distal pancreatectomy—equipoise in current clinical practice?

Since the first reports of minimally invasive distal pancreatectomy 25 years ago (1), widespread adoption into routine clinical practice has been slow (2), largely due to limited formal training opportunities, concerns surrounding oncological safety and the lack of randomised controlled trial data (3). The recent pan-European Minimally Invasive versus Open Distal Pancreatectomy for Ductal Adenocarcinoma (DIPLOMA) study incorporated 1,212 patients from 34 centres with a propensity-matched study design to demonstrate comparable survival and post-operative complication rates between the minimally-invasive vs. open groups (4). However, oncological outcome parameters were contradictory (with a minimally-invasive approach associated with higher R0 resection rates, but lower Gerota’s fascia resection and lymph node yields), strengthening the case for high quality randomised controlled trials in this setting (5). Further, of the 356 minimally invasive distal pancreatectomies included in the DIPLOMA study, only 16 (4%) were performed robotically. Robust evidence to support the theoretical benefits of robotic assistance in facilitating a safe and effective minimally invasive approach to distal pancreatectomy is currently lacking.