Early postoperative outcomes after hybrid minimally invasive pancreaticoduodenectomy with a mini-laparotomy reconstruction: a single-centre randomised feasibility trial

Background: Minimally invasive pancreaticoduodenectomy is being increasingly adopted over the traditional open approach, but this adoption remains limited by a steep learning curve and the need for safe pancreatic and biliary reconstruction. This pilot randomised study evaluated the technical feasibility and safety of our novel hybrid approach, comparing robotic-assisted Whipple’s pancreaticoduodenectomy (RAW), laparoscopic-assisted Whipple’s pancreaticoduodenectomy (LAW), and open Whipple’s pancreaticoduodenectomy (OWL). Methods: Thirty-six patients were randomised equally to the RAW, LAW, and OWL arms. Baseline characteristics, operative duration, Clavien–Dindo morbidity, estimated blood loss (EBL), transfusion requirements, postoperative stay, delayed gastric emptying (DGE), bile leak, CR-POPF rates, pain scores, wound complications, readmission and reoperation rates, and 90-day mortality were analysed. Results: Age and sex distribution were comparable. Mean operative duration was 179.2 ± 27.8 min in RAW, 182.5 ± 32.5 min in LAW, and 165.0 ± 35.0 min in OWL (p = 0.267). Median EBL was lowest in RAW (200 mL), followed by LAW (375 mL) and OWL (500 mL; p = 0.013). Median postoperative stay was 7, 6, and 8 days, respectively (p = 0.228). Bile leak occurred in 2/12 RAW, 2/12 LAW, and 1/12 OWL patients (p = 1.000). CR-POPF occurred in 3/12 RAW, 1/12 LAW, and 0/12 OWL patients (p = 0.294). Pain scores were significantly lower in the minimally invasive groups, particularly RAW. Conclusion: Robotic-assisted and laparoscopic-assisted pancreaticoduodenectomy using a hybrid reconstruction strategy were technically feasible in this pilot randomised study. These findings provide preliminary data to support further evaluation of hybrid minimally invasive pancreaticoduodenectomy in larger randomised studies, with particular focus on perioperative outcomes, safety, and the potential utility of this approach during the adoption of minimally invasive techniques for such complex procedures in resource-limited settings. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2026.