Early clinical impact of mesenteric Kocherization in robotic pancreaticoduodenectomy: a propensity score-matched comparative study.

BACKGROUND

Although robotic pancreaticoduodenectomy (RPD) offers several technical advantages, prolonged operative time remains a major clinical challenge. Mesenteric Kocherization (MK) has recently been introduced as a technical modification for mobilizing the duodenum and pancreatic head during RPD. The present study evaluated the early clinical impact of MK on operative efficiency and perioperative outcomes.

METHODS

We retrospectively reviewed 56 consecutive patients who underwent totally robotic pancreaticoduodenectomy between July 2021 and June 2025. Conventional Kocherization (CK) was performed in 36 patients and MK in 20 patients. The primary outcome was total operative time. Secondary outcomes included console time, Kocherization time, estimated blood loss, transfusion, harvested lymph nodes, R0 resection rate, major postoperative complications (Clavien-Dindo ≥ IIIa), time to first oral intake, and 90-day unplanned readmission rate. To reduce selection bias, propensity score matching was performed using a 1:2 allocation (MK:CK).

RESULTS

In the full cohort, operative time tended to be shorter in the MK group than in the CK group (560 [516-598] vs. 592 [556-667] min; p = 0.057). Kocherization time was significantly shorter with MK (28 [27-36] vs. 50 [40-58] min; p < 0.001), while estimated blood loss was comparable (p = 0.875). After propensity score matching (MK n = 11; CK n = 22), MK was associated with significantly shorter total operative time (533 [511-575] vs. 580 [557-611] min; p = 0.031) and Kocherization time (28 [24-30] vs. 49 [43-55] min; p < 0.001). Blood loss, R0 resection rate, and major postoperative complications were comparable between groups.

CONCLUSIONS

Mesenteric Kocherization was associated with improved operative efficiency in RPD, primarily through shortening the resection phase of the procedure while maintaining perioperative safety.