Anatomy-based individualised trocar placement in robotic pancreatic surgery: challenging the universal approach

Robotic pancreatic surgery has advanced considerably in recent years; however, morbidity and mortality remain significant. Improving outcomes requires standardised procedures with optimised perioperative settings. Proper positioning of robotic trocars plays a key role in enabling safe and effective surgical performance. This study evaluates the impact of anthropometric differences on trocar placement in robotic pancreatic surgery and assesses the feasibility of a universal trocar placement strategy. A retrospective analysis of 103 consecutive contrast-enhanced arterial-phase computed tomography scans was performed. Key distances between the target anatomy and surface landmarks, including the umbilicus and xiphoid process, were measured. The origin of the gastroduodenal artery was selected as the target anatomy for pancreaticoduodenectomy, while the origin of the celiac trunk served as the target anatomy for distal pancreatectomy. The analysis demonstrated that the widely adopted universal periumbilical trocar placement was unsuitable for a substantial proportion of patients. The target anatomy lay outside the recommended range (10–20 cm) in 24% of robotic pancreaticoduodenectomy cases and in 9% of robotic distal pancreatectomy cases. Accordingly, we propose a simple method to optimise patient-tailored yet standardised trocar placement in robotic pancreatic procedures. Conventional vs. Novel Techniques: Robotic pancreatic surgery has emerged as an alternative to open and laparoscopic approaches. A universal approach to trocar placement is widely adopted; however, considerable inter-individual anatomical variability challenges its effectiveness. Modifications and Innovations: This study evaluates an individualised trocar placement strategy tailored to patient-specific anatomical variation. Target anatomy corresponds to the origin of the gastroduodenal artery for pancreaticoduodenectomy and the origin of the celiac trunk for distal pancreatectomy. Preoperative contrast-enhanced computed tomography scans were used for assessment. The tailored approach incorporates measurements between the umbilicus, xiphoid process, and the target anatomy, thereby optimising robotic trocar positioning for each patient. Implications and Recommendations: A standardised trocar placement approach may not be optimal for all robotic pancreatic procedures because of anthropometric differences. An individualised strategy may improve surgical efficiency, minimise instrument collisions, and potentially enhance perioperative outcomes.