AUTHOR=Chen Chuwen , Hu Jing , Yang Hao , Zhuo Xuejun , Ren Qiuping , Feng Qingbo , Wang Miye 

TITLE=Is robotic distal pancreatectomy better than laparoscopic distal pancreatectomy after the learning curve? A systematic review and meta-analysis

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.954227

DOI=10.3389/fonc.2022.954227

ISSN=2234-943X

ABSTRACT=Aim To compare the safety and overall effect of robotic distal pancreatectomy (RDP) to laparoscopic distal pancreatectomy (LDP) after learning curve, especially in perioperative outcome and short-term oncological outcome. 
Methods A literature search was performed by two authors independently using PubMed, Embase and Web of Science to identify any studies comparing the results of RDP versus LDP published until January 5, 2022. Only the studies reporting that the RDP preformed more than 35 cases were included this study. We performed a meta-analysis of operative time, blood loss, reoperation, readmission, hospital stay, overall complications, major complications, postoperative pancreatic fistula (POPF), blood transfusion, conversion to open surgery, spleen preservation, tumor size, R0-resection and lymph node dissection.
Results Our search identified 15 eligible studies, totaling 4062 patients (1413 RDP). It seems that the RDP group had a high rate of smaller tumor size than those in the LDP group (MD: -0.15; 95% CI: -0.20 to -0.09; p<0.00001). Furthermore, compared with LPD, RDP was associated with a higher spleen preservation rate (OR:2.19; 95% CI: 1.36–3.54; p＝0.001) and lower rate of conversion to open surgery (OR: 0.43; 95% CI: 0.33–0.55; p< 0.00001). Our study revealed that there were no significant differences in operative time, overall complications, major complications, blood loss, blood transfusion, reoperation, readmission, POPF and lymph node dissection between RDP and LDP.
Conclusions RDP is safe and feasible for distal pancreatectomy compared with LDP and it can reduce the rate of conversion to open surgery and increase the rate of spleen preservation, which requires large sample and quality comparative studies to further confirm.