Robotics vs. laparoscopy in spleen-preserving distal pancreatectomy in the IGOMIPS registry: when glitter does not equal superiority

Spleen-preserving distal pancreatectomy (SPDP) reduces the risks associated with splenectomy and can be performed laparoscopically (Lap-SPDP) or robotically (Rob-SPDP). Whether robotic assistance improves spleen preservation compared with laparoscopy remains unclear. A retrospective cohort study was conducted using the prospective Italian Registry of Minimally Invasive Pancreatic Surgery (IGOMIPS). All consecutive patients scheduled for SPDP between September 2019 and July 2024 were analyzed according to an intention-to-treat protocol. Primary endpoint was intraoperative deviation from planned SPDP; secondary endpoints included intra- and postoperative outcomes. Propensity score matching was performed to adjust for baseline variables, with a second propensity score matching including center volume and surgeon experience. Of 3045 procedures, 270 were planned SPDP (Rob-SPDP n = 138, Lap-SPDP n = 132). Overall intraoperative deviation occurred in 22.6% of cases, most commonly conversion to distal pancreatectomy with splenectomy. Spleen-vessel preservation rates were similar for Rob-SPDP (87.9) and Lap-SPDP (90.6%; p = 0.5561). Robotic procedures had longer operative time but lower stapler use. No significant differences were observed in severe complications, mortality, length of stay, or other postoperative outcomes in unmatched or matched cohorts. Robotic use increased significantly over time and was predominant in centers with robotic platforms and higher volumes. In a prospective national registry, Lap-SPDP and Rob-SPDP achieved comparable spleen preservation rates and perioperative outcomes. Robotic assistance did not confer measurable clinical advantages, though its adoption is increasing, particularly in high-volume, well-equipped centers.