Silvio Caringi, Antonella Delvecchio, Annachiara Casella, Cataldo De Palma, Valentina Ferraro, Rosalinda Filippo, Matteo Stasi, Nunzio Tralli, Tommaso Maria Manzia, Riccardo Memeo, Michele Tedeschi
BACKGROUND: Robotic pancreaticoduodenectomy (RPD) is a less invasive alternative to open pancreaticoduodenectomy (OPD) with the potential for perioperative advantage. Concerns remain regarding its technical difficulty, cost, and oncologic adequacy. METHODS: Review of PubMed, MEDLINE, Scopus, and Embase databases was conducted (January 2000-October 2025), focusing on systematic reviews, meta-analyses, and significant comparative studies of RPD. Outcomes assessed were perioperative outcomes, oncologic sufficiency, learning curve, model training, cost-effectiveness, and future developments. RESULTS: Several studies report comparable R0 rates and lymph node yield between RPD and OPD, with reduced blood loss, shorter postoperative hospital stay, and faster recovery in high-volume centers. Morbidity (35-50%) and 90-day mortality (<2%) are similar to open or laparoscopic surgery. Competence is usually achieved after 40-60 cases, while optimal outcomes are achieved after 80-100 procedures. Structured mentorship and simulation training improve safety and reproducibility. Novel technologies such as augmented reality, intraoperative fluorescence, and artificial intelligence-based navigation may also enhance accuracy and shorten the learning curve. CONCLUSIONS: RPD appears to be a safe and effective minimally invasive option in carefully selected patients if done in specialized, high-volume centers. Future studies need to resolve long-term oncologic results, cost-effectiveness, and the role of next-generation robotic systems.