Reproducibility of robotic transgastric cystgastrostomy in management of post-pancreatitis fluid collections.

Robotic transgastric cystgastrostomy is an effective minimally invasive treatment for symptomatic post-pancreatitis fluid collections. Although favorable outcomes have been reported at high-volume tertiary hepatopancreatobiliary (HPB) centers, reproducibility of this technique at affiliate HPB institutions remains poorly defined. A retrospective review was performed of consecutive patients undergoing robotic transgastric cystgastrostomy for symptomatic post-pancreatitis fluid collections at an affiliate HPB center between 2023 and 2025. Demographic, operative, and postoperative outcomes were analyzed. Primary outcome was clinical symptom resolution. Thirty-six patients underwent robotic transgastric cystgastrostomy. WON was present in 63.9% of patients and median collection size was 11.8 cm. Median operative time was 203 min with estimated blood loss of 23 mL. Median postoperative length of stay was 5.5 days. Concomitant cholecystectomy was performed in 66.6% of cases, while adjunctive postoperative IR and GI interventions were required in select patients. Clinical symptom resolution occurred in 35 of 36 patients (97.2%). There were no conversions to open surgery, reoperations, or mortalities during follow-up. Robotic transgastric cystgastrostomy can be safely performed at an affiliate HPB center with high clinical success and low morbidity. These findings support feasibility of robotic transgastric internal drainage techniques within integrated HPB systems.