Robot-assisted pancreatic necrosectomy for infected pancreatic necrosis secondary to severe acute pancreatitis: a single-center retrospective cohort study.

Infected pancreatic necrosis (IPN) is a severe late complication of severe acute pancreatitis (SAP). Although step-up treatment has reduced the need for open pancreatic necrosectomy (OPN), the role of robot-assisted pancreatic necrosectomy (RAPN) remains unclear. We retrospectively analyzed 107 patients with SAP-related IPN who underwent surgery after failed conservative therapy and percutaneous catheter drainage from January 2020 to December 2025. Patients were grouped as RAPN (n = 26), conventional minimally invasive surgery (CMIS; n = 47), or OPN (n = 34). Outcomes and single-intervention success were compared, and logistic regression identified associated factors. Measured baseline characteristics did not differ significantly among groups. RAPN had longer operative time than CMIS and OPN, but less blood loss and fewer drainage tubes than OPN. No RAPN patient required postoperative intensive care. RAPN was associated with shorter urinary catheterization, less analgesic use, fewer severe treatment-related adverse events, and fewer overall complications than OPN, and with earlier ambulation and higher single-intervention success than CMIS. RAPN independently predicted single-intervention success (OR, 4.767; 95% CI, 1.280-17.754; p = 0.020), whereas higher modified CT severity index score reduced the odds of success (OR, 0.624; 95% CI, 0.438-0.890; p = 0.009). Total surgery-related hospitalization costs were similar. RAPN appears safe and feasible for selected SAP-related IPN patients within a step-up framework. Its favorable recovery and complication profile should be interpreted cautiously because of the retrospective design and possible selection bias.