Minimally Invasive Surgery Proven Safe and Effective for Complex ‘Whipple’ Procedure

Tumors of the pancreatic head often require a highly complex operation known as pancreatoduodenectomy or the Whipple procedure. This surgery involves removing multiple structures and creating several internal reconnections, making it one of the most demanding abdominal operations. Traditionally performed as open surgery, it carries substantial recovery time and complication risks. New clinical trial evidence now shows that a less invasive approach can achieve similar safety while improving recovery.

The trial, coordinated by Amsterdam UMC (Amsterdam, The Netherlands), in collaboration with leading European surgical centers, evaluated minimally invasive pancreatoduodenectomy, performed using advanced laparoscopic and robotic techniques, and compared it with conventional open surgery. The minimally invasive approach uses small incisions and robotic assistance to enhance visualization, precision, and dexterity during tumor removal and reconstruction of pancreatic, biliary, and gastric connections.

The international DIPLOMA-2 randomized clinical trial included 288 patients treated across 14 expert centers in six European countries. Patients were assigned in a 2:1 ratio to minimally invasive or open surgery and monitored for postoperative outcomes over 90 days. Results showed comparable overall complication rates between both groups, with the minimally invasive group experiencing shorter hospital stays, fewer wound complications, and fewer anastomotic leaks.

The findings, published in New England Journal of Medicine Evidence, confirm that minimally invasive surgery is a safe alternative for pancreatic head tumors when performed in high-volume expert centers. Faster recovery and reduced surgical trauma may improve the quality of life and postoperative resilience for patients undergoing this demanding procedure. Researchers have launched a follow-up trial, DIPLOMA-2x2, to assess whether long-term cancer outcomes with robotic surgery are comparable to open approaches in malignant cases.

“These results mark an important turning point,” said co-principal investigator Dr. Mohammad Abu Hilal. “Minimally invasive surgery can now be considered a fully valid alternative even for the most complex pancreatic operation.”

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