Robotic versus laparoscopic approaches to neonatal annular pancreas: a comparative analysis of surgical outcomes and innovation trade-offs.

OBJECTIVE

To evaluate the safety and to efficacy of robotic-assisted duodenoduodenostomy (RAD) and laparoscopic-assisted duodenoduodenostomy (LAD) for neonatal annular pancreas and analyze its associated learning curve.

METHODS

A retrospective analysis of 59 neonates undergoing minimally invasive DS (2019-2024) was performed. Patients were stratified into robotic (RAD, n = 25) and laparoscopic (LAD, n = 34) cohorts. Perioperative outcomes (operative time, anastomosis time, blood loss, drainage duration, complications) were compared. Learning curves for console docking and intracorporeal manipulation were assessed using cumulative sum (CUSUM) analysis.

RESULTS

RAD demonstrated significantly shorter anastomosis time (35.6 ± 2.4 min vs. 47.0 ± 4.1 min, P < 0.05), reduced blood loss (median 4.0 ml vs. 6.0 ml, P < 0.05), and earlier drain removal (median 4.0 vs. 5.0 days, P < 0.05) compared to LAD. operative time was longer for RAD (179.3 ± 21.1 min vs. 156.9 ± 23.1 min, P < 0.05), attributed to docking time (22.2 ± 5.9 min) and the learning curve. Complication rates were comparable (16.0% vs. 26.5%, P = 0.537), with no anastomotic leaks, strictures or reoperations in either group. CUSUM analysis identified proficiency thresholds: docking time plateaued at case 13, and intracorporeal manipulation stabilized after 10 cases. Preliminary analysis within the first 20 cases suggests a 20-case threshold may be critical procedural mastery.

CONCLUSION

RAD is a safe and effective approach for neonatal annular pancreas, demonstrating superior precision to laparoscopy. While requiring a longer initial operative time, RAD provides significant advantages in anastomotic efficiency and hemostasis once the learning curve is overcome.