Short-term outcomes of robotic-assisted distal pancreatectomy using domestic KangDuo Surgical Robot-2000 System versus Da Vinci Xi system: a two-center prospective observational cohort study.

OBJECTIVE: Robotic surgery is a transformative approach for abdominal tumors. With the emergence of multiple robotic systems, evidence on their comparative oncological outcomes remains limited. This two-center prospective observational cohort study aimed to compare surgical efficacy and short-term oncological outcomes between the novel KangDuo Surgical Robot System-2000 (KD-SR-2000) and the Da Vinci Xi system in robot-assisted distal pancreatectomy (RDP). METHODS: This two-center prospective observational cohort study enrolled patients with pancreatic tumors who scheduled for RDP at Peking Union Medical College Hospital and Peking University First Hospital between December 2023 and May 2025. Eligible patients were assigned into either the KD-SR-2000 group (n = 33) or the Da Vinci Xi group (n = 50) in a non-randomized, non-blinded manner. Baseline demographics, perioperative parameters, postoperative complications, ergonomics, and hospitalization costs were prospectively collected and compared between groups. RESULTS: Baseline characteristics were balanced. One case in the Da Vinci Xi group was converted to laparotomy due to severe adhesions and splenic vein bleeding. No significant differences were observed in surgical success, conversion, spleen preservation, or 90-day mortality rates (all P > 0.05). NASA-TLX scores indicated higher physical demand, effort, and total workload in the KD-SR-2000 group, though differences were not significant (all P > 0.05). Major complications (Clavien-Dindo ≥ III) and specific complications showed no significant differences. The KD-SR-2000 group had significantly lower hospitalization costs ($8131.6 [7642.4-9960.7] vs. $9859.6 [9022.4-18,965.8], P < 0.001). Intraoperative blood loss, operation time, and postoperative stay did not differ significantly. CONCLUSIONS: In this preliminary prospective observational study, the KD-SR-2000 system demonstrated comparable efficacy and safety to the Da Vinci Xi in the RDP procedure. While further improvements are needed in its ergonomic design, it possesses significant advantages in surgical costs and may be considered a viable alternative to the Da Vinci Xi system.