Robotic versus laparoscopic pancreatoduodenectomy across the learning curve: a systematic review and meta-analysis.

BACKGROUND

Minimally invasive pancreatoduodenectomy (MIPD) has a substantial learning curve. This systematic review and meta-analysis evaluated learning-phase effects in robotic (RPD) and laparoscopic pancreatoduodenectomy (LPD).

METHODS

The protocol was registered in PROSPERO (CRD420261283406). PubMed, Scopus, and Web of Science were searched through June 1, 2026. Studies reporting early-versus-late learning-phase outcomes or phase-specific RPD-versus-LPD comparisons were included. Random-effects models were used, and the certainty of evidence was assessed using GRADE.

RESULTS

Twenty-five studies were included qualitatively and 20 quantitatively, comprising 4,764 patients. The median case volume required to overcome the learning curve was similar for RPD and LPD (31.5 vs. 35 cases; p = 0.56). Late-phase MIPD was associated with significantly shorter operative time, lower estimated blood loss, lower conversion rate, shorter length of stay, and reduced rates of POPF, bile leak, and delayed gastric emptying. During the early phase, RPD had a longer operative time but a shorter length of stay and a lower CR-POPF than LPD. In the late phase, RPD showed lower conversion, while most other outcomes were comparable.

CONCLUSION

Both RPD and LPD improve with experience. RPD may offer selected learning-phase advantages, but current evidence does not support broad superiority over LPD.