Background : Robotic pancreaticoduodenectomy (RPD) is increasingly adopted for the advantages offered by the robotic platform, especially in the reconstructive phase, prompting many institutions to shift directly from open to robotic approaches. This study aims to ensure surgical performance quality during RPD implementation by sequentially monitoring postoperative outcomes through the transition, using cumulative sum (CUSUM) chart analysis.

Methods : This single center, retrospective study, included consecutive patients undergoing open or robotic PD, for any pancreatic disease, following an intention-to-treat principle. Demographics, surgical and postoperative data were collected. CUSUM analysis monitored safety and quality outcomes during the implementation period, including the preceding open cases and all subsequent RPD. Variations in performance were assessed using segmented regression (broken line modelling).

Results : Fifty-nine patients underwent PD (29 open, 30 robotic) until December 2022, with 51 undergoing surgery for malignancy. POPF occurred in 22%, DGE in 14%, PPH in 15%, and bile leakage in 7%, with 36.8% experiencing complications of Clavien-Dindo grade ≥ 3a. No significant difference in postoperative complications existed between the open and robotic groups. CUSUM analysis revealed no variation in surgical performance (considering clinically significant POPF, DGE, PPH, severe complications) following the transition to the robotic approach.

Conclusions : RPD can be safely implemented in a pancreatic surgery program, even in the absence of a previous experience of laparoscopic pancreatic surgery, without any risk of transient deterioration in postoperative outcomes.