Exploring the landscape of minimally invasive pancreatic surgery: Progress, challenges, and future directions

Abstract

Minimally invasive surgery (MI) has become the standard of care for many surgical procedures aimed at reducing the burden on patients. However, its adoption in pancreatic surgery (PS) has been limited by the pancreas’s unique location and the complexity of the dissection and reconstruction phases. These factors continue to contribute to PS having one of the highest morbidity and mortality rates in general surgery. Despite a rough start, MIPS has gained widespread acceptance in clinical practice recently. Robust evidence supports MI distal pancreatectomy safety, even in oncological cases, indicating its potential superiority over open surgery. However, definitive evidence of MI pancreaticoduodenectomy (MIPD) feasibility and safety, particularly for malignant lesions, is still lacking. Nonetheless, reports from high-volume centers are emerging, suggesting outcomes comparable to those of the open approach. The robotic PS increasing adoption, facilitated by the wider availability of robotic platforms, may further facilitate the transition to MIPD by overcoming the technical constraints associated with laparoscopy and accelerating the learning curve. Although the MIPS implementation process cannot be stopped in this evolving world, ensuring patient safety through strict outcome monitoring is critical. Investing in younger surgeons with structured and recognized training programs can promote safe expansion.

Keywords: Minimally invasive surgery; Minimally invasive pancreatic surgery; Pancreatic surgery; Robotic; Laparoscopic; Pancreaticoduodenectomy; Distal pancreatectomy

Core Tip: Implementation of minimally invasive pancreatic surgery (MIPS) is a process that cannot be stopped. Minimally invasive (MI) distal pancreatectomy is now well-supported by evidence showing its safety and potential superiority over open surgery. Although the feasibility and definitive evidence for MI pancreaticoduodenectomy (MIPD) remain under investigation, high-volume centers have reported promising outcomes. The rise of robotic pancreatic surgery is poised to overcome technical limitations and enhance the transition to MIPD. Ensuring patient safety through rigorous monitoring and structured training of surgeons is crucial for the continued safe implementation of MIPS.