Comparison of different pancreatic stump management strategies during robot-assisted distal pancreatectomy

Background Postoperative pancreatic fistula (POPF) represents the most feared complication after distal pancreatectomy, and the possible role of robotic assistance in this setting is poorly investigated so far. Methods We analysed short-term outcomes of 88 patients who had undergone robot-assisted distal pancreatectomy (RDP), dividing them according to pancreatic stump management: selective Wirsung duct ligation/hand sewn suture (WirsLIG group), use of robotic EndoWrist staplers (RobSTAP group), and use of laparoscopic staplers (LapSTAP group). Results Mean operative time resulted significantly longer in WirsLIG group (291.1 +/- 77.21 min vs. 245 +/- 56.22 min in RobSTAP group vs. 221.77 +/- 64.64 min in LapSTAP group). No significant differences were found in median hospital stay and in POPF occurrence. Conclusions No strategy for pancreatic stump management during RDP has proven superior to the others in reducing POPF rates. The hand-sewn technique resulted more time consuming, nevertheless it remains essential where there is not enough space to insert the stapler.