Impact of visceral fat area on surgical difficulty during robotic distal pancreatectomy (TAKUMI-2).

Background: Difficulty scoring systems (DSS) have been developed to quantify the surgical complexity of laparoscopic distal pancreatectomy (LDP). However, few studies have validated these systems in the context of robotic distal pancreatectomy (RDP). Moreover, the impact of body composition on RDP outcomes remains unexplored. This study aimed to investigate the risk factors of surgical difficulty in RDP, including body composition.

Methods: This retrospective study included 72 consecutive patients who underwent RDP at our institution between April 2021 and October 2024. Using a modified DSS for LDP, patients were divided into three difficulty index groups. The association between the difficulty index and outcomes was investigated. Multivariate analyses were performed to identify risk factors associated with surgical difficulty (prolonged operative time) in RDP.

Results: Patients were classified into three difficulty index groups: low (n = 28), intermediate (n = 25), and high (n = 19). Operative time was significantly associated with the surgical index (P = 0.01). Moreover, visceral fat area (VFA) was significantly correlated with operative time (r² = 0.10, P = 0.008). The multivariate analyses found that VFA (≥ 100 cm²) (odds ratio [OR] 5.03, 95% confidence interval [CI] 1.32-22.4, P = 0.02), malignancy (OR 4.92, 95% CI 1.50-18.9, P = 0.01), and pancreatic resection on the portal vein (OR 4.14, 95% CI 1.24-15.9, P = 0.02) were significant risk factors associated with surgical difficulty.

Conclusion: VFA could be a novel and useful factor for assessing the surgical difficulty associated with RDP.