Minimally invasive procedures in pancreatic surgery

Thanks to modern technologies and decades of surgical experience, operations on the pancreas can now be performed using minimally invasive techniques in many cases. Instead of a large incision in the abdomen, the procedure is performed through a few small incisions in the skin, through which a camera and specialized instruments are inserted. These so-called atraumatic approaches are gentle on the tissue, result in less pain, faster recovery, and often shorter hospital stays.

Robot-assisted surgery—usually performed using the state-of-the-art da Vinci surgical system—is currently the most advanced form of this technology. It provides surgeons with a high-resolution 3D view of the surgical site, precise control of the instruments, and very fine movement transmission. Studies show that robotic pancreatic surgery, when used for appropriate indications, can result in less blood loss, shorter hospital stays, and a faster return to everyday life.

At the Botton-Champalimaud Pancreatic Cancer Center in Lisbon, Prof. Dr. Dr. Markus W. Büchler and his team use this technique on a daily basis—particularly for neuroendocrine tumors, cystic changes, and selected benign or malignant tumors where safe resection is possible without compromising radicality.

Limitations of minimally invasive surgery in pancreatic cancer

In most cases of aggressive pancreatic cancer (ductal adenocarcinoma), open surgery remains the procedure of choice. The reason: these tumors often affect lymph nodes, blood vessels, and nerves in the immediate vicinity of the pancreas. Such complex structures can only be treated robotically with the required precision and radicality to a very limited extent. Compromises in surgical technique would be inappropriate here—the goal remains complete tumor removal with maximum oncological safety.

Looking to the future

Currently, around 20% of pancreatic surgeries at the center are performed using minimally invasive or robotic techniques. With further technical developments, improved instrument technology, and increasing surgical experience, it is expected that the proportion of these minimally invasive procedures will increase significantly in the coming years—provided that they offer patients the same oncological benefits as open surgery.