Background and Aims: Minimally invasive surgery has been rapidly adopted in all surgical specialties, due to its advantages of small incision, reduced trauma and pain as well as quick recovery. The rise of surgical robots brings the minimally invasive surgery into a new era of development, which also conforms to the concept of enhanced recovery after surgery (ERAS). This study was conducted to evaluate the practicability and application value of using da Vinci robot operation system in pancreaticoduodenectomy (PD) for pancreatic cancer. 
Methods: The clinical data of 61 patients undergoing minimally invasive PD for pancreatic cancer from January 2016 to May 2019 in the Department of General Surgery of the Third Xiangya Hospital, Central South University were analyzed retrospectively. Of the patients, 24 cases underwent a da Vinci robot-assisted PD (RPD group) and 37 cases underwent the conventional laparoscopic PD (LPD group). The main clinical variables during the perioperative period were compared between the two groups of patients.
Results: There were no significant differences in the preoperative data between the two groups of patients (all P>0.05). In RPD group compared with LPD group, the open conversion rate was significantly decreased (4.2% vs. 8.1%, χ2=4.565, P=0.033), the intraoperative blood loss was significantly reduced (255.0 mL vs. 380.0 mL, Z=–5.813, P<0.001), and the number of resected lymph nodes was significantly elevated (17.0 vs. 11.0, Z=–6.133, P<0.001), but the operative time was significantly prolonged (466.5 min vs. 375.0 min, Z=–6.568, P<0.001). All the surgical margins in both groups were negative reported by postoperative pathology, and there were no significant difference in the pathological results between the two groups (P>0.05); There were no significant differences in the amount of 24-h drainage, and the times to the first postoperative anal gas passage, food intake and ambulation as well as the time for the urinary catheter and wound drainage tube removal between the two groups (all P>0.05); the hospitalization cost of RPD group was significantly higher than that of LPD group (114 154.84 yuan vs. 86 749.59 yuan, Z=–5.863, P<0.001), but the length of hospital stay of RPD group was significantly shorter than that of LPD group (14.0 d vs. 18.0 d, Z=–5.930, P<0.001). Twenty-one cases in RPD group and 33 cases in LPD group were followed up for 22 month, and the 3-year survival rates showed no significant difference between the two groups (20.8% vs. 24.3%, P>0.05).
Conclusion: The assistance of da Vinci robot can improve the quality of PD operation, shorten the recovery time of patients, and is safe and feasible, in line with the concept of ERAS. However, the treatment cost is high, so the family economic situation of patients should be fully considered in choosing this operation.