Introduction : Postoperative pancreatic fistula (POPF) is one of the most dreaded conditions after pancreaticoduodenectomy (PD). With advancement in minimally invasive surgery (MIS) the drive to ensure that POPF rates are comparable to open techniques has become paramount. The advantage of articulating robotic instruments has reduced the technical demands of forming a pancreatico-jejunostomy and hepatico-jejunostomy, however the absence of tactile feedback adds an element of difficulty previously not encountered.

Methods : Patients with early pancreatic head tumor and periampullary tumor were offered the options of MIS PD. Patients can opt for either laparoscopic or robotic assisted operation depending on their financial means. Repeated dry laboratory simulations were performed mimicking the exact port placements and materials with similar characteristic to bile duct and pancreas were performed prior to the actual operation.

Results : 4 robotic assisted PDs were performed for duodenal tumor, ampullary tumors and head of pancreas tumor. The case with head of pancreas tumor was converted to open in view of tumor adhesion to the SMV and bleeding encountered during the dissection. One case was performed simultaneously with robotic right partial nephrectomy for renal cell carcinoma. Only one patient had grade A POPF. The mean length of stay was 12.5 days.

Conclusions : Simulation training with products with similar consistency to the pancreas and bile duct may aid in the surmounting the learning curve for complex procedures like robotic PD.