Robotic superior mesenteric and portal vein resections in major liver, biliary, and pancreatic surgery

The robotic approach to liver and pancreatic surgery is expanding worldwide. However, limited data are available on vascular management in these complex procedures. The unique characteristics of the robotic platform may enhance the feasibility of minimally invasive vascular resection and reconstruction. This retrospective, single-arm, single-center study includes patients who underwent liver, biliary, and pancreatic resections with superior mesenteric and portal vein resection performed robotically between April 2021 and June 2024. The study evaluates short-term outcomes and provides technical insights. Eight patients underwent superior mesenteric or portal vein resection during the study period. Among them, six cases occurred during pancreatic resections, while two were performed during liver resections. In four cases, the chosen strategy involved tangential clamping and direct suturing (Type 1). In two cases, the vessel was repaired using a patch (Type 2). The remaining two cases required end-to-end anastomosis-one performed directly (Type 3) and one with the interposition of a prosthetic graft (Type 4). Postoperatively, only two patients developed complications classified as > 3a according to the Clavien classification, with Comprehensive Complication Index (CCI) scores of 47.6 and 37.1, respectively. Vascular reconstructive skills are essential for surgeons performing hepatopancreatobiliary (HPB) surgery to achieve R0 resections in locally advanced cases. The robotic approach to vascular resection and reconstruction requires a stepwise implementation to ensure favorable oncologic and postoperative outcomes.