344 Robotic vs Open Pancreaticoduodenectomy in a Single High-Volume Tertiary HPB Unit; Initial Experience

Abstract Aim To evaluate the safety and perioperative outcomes of a newly implemented robotic pancreaticoduodenectomy (RPD) programme compared to open pancreaticoduodenectomy (OPD) at a tertiary hepatopancreaticobiliary centre. Method A retrospective analysis of all pancreaticoduodenectomies was conducted between July 2023 and June 2025. Patients were grouped by surgical approach (RPD vs OPD). Outcomes included intraoperative blood loss, conversion rate, R0 margin status, pancreatic fistula rate (POPF grade B/C), length of stay (LOS), Clavien-Dindo grade III+ (C-DIII+) complications, and 90-day mortality. Statistical comparisons were performed using Mann-Whitney U, Chi-square, and Fisher’s exact tests. Results A total of 32 RPD and 116 OPD procedures were performed. Baseline characteristics were comparable (median age: 69 vs 67 years; BMI: 28.1 vs 26.2 kg/m²).Median intraoperative blood loss was significantly lower in RPD (200 mL vs 750 mL, p<0.001).Conversion to open occurred in 2 of 33 RPD cases.RPD was associated with significantly shorter HDU stay (2.0 vs 3.0 days, p=0.004) and overall LOS (7.0 vs 9.0 days, p=0.004).POPF rates were lower in RPD (3.1% vs 15.5%, p=0.076), as were C-D III+ complications (6.3% vs 14.7%, p=0.369).R0 resection was achieved more frequently in RPD (71.4% vs 55.0%, p=0.164).Ninety-day mortality was 3.0% for RPD and 0% for OPD (p=0.216). Conclusions Robotic pancreaticoduodenectomy is safe and feasible during early adoption, with significantly reduced blood loss and hospital stay. While not all differences reached statistical significance, trends suggest favourable outcomes. Further analysis using propensity score matching is planned to adjust for baseline differences and better evaluate comparative effectiveness.