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JCM
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State of the Art in Hepato-Pancreato-Biliary (HPB) Surgery
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State of the Art in Hepato-Pancreato-Biliary (HPB) Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (28 November 2025) | Viewed by 2621

Special Issue Editors

Dr. Pantelis Antonakis

E-Mail Website
Guest Editor
2nd Department of Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
Interests: laparoscopic surgery; robotic surgery; pancreatic surgery; gastric surgery; adrenal surgery
Dr. Konstantinos Bramis

E-Mail Website
Guest Editor
2nd Department of Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
Interests: HBP surgery; robotic surgery; laparoscopic surgery

Special Issue Information

Dear Colleagues,

Hepato-pancreato-biliary (HPB) surgery is continually advancing, driven by significant improvements in surgical techniques, technological innovations, and multidisciplinary collaborations. Despite considerable progress, substantial challenges persist, including the management of complex hepatic resections, the optimization of outcomes in pancreatic surgery, and the enhancement of safety and efficacy in biliary interventions. Emerging technologies, minimally invasive approaches, and advancements in perioperative care have demonstrated considerable potential; however, robust evidence and innovative strategies remain essential to effectively address existing clinical gaps.

In response to these ongoing developments, the Journal of Clinical Medicine (JCM) is pleased to announce a Special Issue entitled “State of the Art in Hepato-Pancreato-Biliary (HPB) Surgery”. This Special Issue aims to highlight recent breakthroughs, underscore current standards of care, and examine state-of-the-art advancements, particularly in the domain of minimally invasive surgery. We warmly invite original research articles, comprehensive reviews, and detailed case series that address innovative surgical methodologies, technological progress, enhancements in patient safety, and evidence-based perioperative management in HPB surgery. Your valuable contributions will play a significant role in shaping future clinical practice and improving patient outcomes within the field.

Dr. Pantelis Antonakis
Dr. Konstantinos Bramis
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hepato-pancreato-biliary (HPB) surgery
  • robotic surgery
  • laparoscopic surgery
  • liver resection
  • liver transplantation
  • pancreatectomy
  • liver thermoablation
  • extrahepatic cholangiocarcinoma
  • benign biliary disease
  • pancreatic neuroendocrine tumors
  • non-colorectal/non-neuroendocrine oligometastatic liver disease

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Published Papers (2 papers)

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Review

12 pages, 229 KB  
Review
From Open to Robot-Assisted Pancreatoduodenectomy: What RCTs Really Show
by Alice Cattelani, Roberto M. Montorsi, Alessio Marchetti, Lucia Landi, Federico Gronchi, Matteo De Pastena, Luca Landoni, Alessandro Esposito, Salvatore Paiella, Giuseppe Malleo and Roberto Salvia
J. Clin. Med. 2026, 15(3), 1225; https://doi.org/10.3390/jcm15031225 - 4 Feb 2026
Viewed by 684
Abstract
Introduction: Minimally invasive pancreatoduodenectomy (MIPD), including laparoscopic (LPD) and robotic approaches (RPD), has gained increasing attention as an alternative to open pancreatoduodenectomy (OPD). Despite rapid technological progress, concerns persist regarding safety, reproducibility, and oncological adequacy. The publication of randomized controlled trials (RCTs) [...] Read more.
Introduction: Minimally invasive pancreatoduodenectomy (MIPD), including laparoscopic (LPD) and robotic approaches (RPD), has gained increasing attention as an alternative to open pancreatoduodenectomy (OPD). Despite rapid technological progress, concerns persist regarding safety, reproducibility, and oncological adequacy. The publication of randomized controlled trials (RCTs) provides essential high-level evidence to reassess the true benefits and limitations of MIPD. Methods: This narrative review synthesizes all available RCTs comparing LPD and RPD with OPD. Major domains evaluated include mortality, major morbidity, intraoperative parameters, postoperative recovery, oncological outcomes, conversion, costs, and the influence of surgeon experience and institutional volume. The objective is to contextualize RCT findings rather than perform a quantitative meta-analysis. Discussion: Across studies, LPD demonstrates comparable mortality and complication rates to OPD in high-volume centers, with consistent reductions intraoperative blood loss (IBL) and shorter recovery or length of stay (LOS). RPD shows more heterogeneous results: one large trial reported improved postoperative recovery, whereas the EUROPA trial identified higher rates of pancreatic fistula (POPF) and delayed gastric emptying (DGE) alongside significantly increased costs. Both LPD and RPD achieve oncological outcomes equivalent to OPD, and 3-year survival data confirm the long-term non-inferiority of LPD. However, operative time remains longer for all minimally invasive approaches, and conversion persists as a marker of technical difficulty and incomplete learning curve. Conclusions: Current RCT evidence indicates that MIPD is safe, feasible, and oncologically sound only when performed by surgeons who have surpassed the demanding learning curve within specialized, high-volume centers. The benefits, mainly reduced IBL and faster recovery, must be weighed against longer operative times, conversion risks, and substantially higher costs for RPD. MIPD should therefore be considered an advanced option rather than a universal standard, and its broader implementation requires structured training pathways, appropriate patient selection, and institutional readiness. Full article
(This article belongs to the Special Issue State of the Art in Hepato-Pancreato-Biliary (HPB) Surgery)
17 pages, 375 KB  
Review
Robotic Pancreaticoduodenectomy: Current Evidence and Future Perspectives
by Silvio Caringi, Antonella Delvecchio, Annachiara Casella, Cataldo De Palma, Valentina Ferraro, Rosalinda Filippo, Matteo Stasi, Nunzio Tralli, Tommaso Maria Manzia, Riccardo Memeo and Michele Tedeschi
J. Clin. Med. 2025, 14(23), 8372; https://doi.org/10.3390/jcm14238372 - 25 Nov 2025
Cited by 2 | Viewed by 1569
Abstract
Background: Robotic pancreaticoduodenectomy (RPD) is a less invasive alternative to open pancreaticoduodenectomy (OPD) with the potential for perioperative advantage. Concerns remain regarding its technical difficulty, cost, and oncologic adequacy. Methods: Review of PubMed, MEDLINE, Scopus, and Embase databases was conducted (January 2000–October 2025), [...] Read more.
Background: Robotic pancreaticoduodenectomy (RPD) is a less invasive alternative to open pancreaticoduodenectomy (OPD) with the potential for perioperative advantage. Concerns remain regarding its technical difficulty, cost, and oncologic adequacy. Methods: Review of PubMed, MEDLINE, Scopus, and Embase databases was conducted (January 2000–October 2025), focusing on systematic reviews, meta-analyses, and significant comparative studies of RPD. Outcomes assessed were perioperative outcomes, oncologic sufficiency, learning curve, model training, cost-effectiveness, and future developments. Results: Several studies report comparable R0 rates and lymph node yield between RPD and OPD, with reduced blood loss, shorter postoperative hospital stay, and faster recovery in high-volume centers. Morbidity (35–50%) and 90-day mortality (<2%) are similar to open or laparoscopic surgery. Competence is usually achieved after 40–60 cases, while optimal outcomes are achieved after 80–100 procedures. Structured mentorship and simulation training improve safety and reproducibility. Novel technologies such as augmented reality, intraoperative fluorescence, and artificial intelligence-based navigation may also enhance accuracy and shorten the learning curve. Conclusions: RPD appears to be a safe and effective minimally invasive option in carefully selected patients if done in specialized, high-volume centers. Future studies need to resolve long-term oncologic results, cost-effectiveness, and the role of next-generation robotic systems. Full article
(This article belongs to the Special Issue State of the Art in Hepato-Pancreato-Biliary (HPB) Surgery)
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