TABLE 2.

Terminology and Definitions of Surgical Approaches

Approach	Definition
Laparoscopic	The procedure is fully performed through laparoscopic ports.
Roboscopic (This applies to PD/TP/CP)	The procedure is performed minimally invasively, using both laparoscopic and robot-assisted approaches. It is characterized by the placement of 3–4 robotic ports and 1 or more laparoscopic ports. The robot can be docked at any time during the surgery. The resection is performed laparoscopically and reconstructive phase by combining the laparoscopic and robotic techniques. At least 1 anastomosis is performed using the robot-assisted technique.
Pure Robotic	The procedure is performed through 3–4 robotic ports and 1 or more laparoscopic ports. The robot is docked at the beginning of the surgery. Both the pancreas resection and reconstructive phase (when expected) are carried out using robotic instruments. No laparoscopic energy device is used in pure-robotic procedures.
Robot-assisted (This applies to PD/TP/CP/DP)	The procedure is performed through 3–4 robotic ports and 1 or more laparoscopic ports. The robot is docked at the beginning of the surgery. The pancreas resection phase is carried out using both robotic and laparoscopic instruments. When expected, the reconstructive phase is carried out using exclusively robotic instruments.
Open	The procedure is fully performed through a laparotomy incision without the use of any minimally invasive technique.
Hand-assisted Laparoscopic	The procedure is performed through laparoscopic ports and an auxiliary hand port. The procedure is performed laparoscopically, 1 surgeon’s hand is placed through the hand port and mostly used for retraction and palpation.
Hand-assisted Robotic	The procedure is performed under robotic assistance and through robotic ports. An auxiliary hand-port is also used. The procedure is performed robotically, 1 surgeon’s hand is placed through the hand port and mostly used for retraction and palpation.
Single-port Laparoscopic	The procedure is performed through a single glove port using several either standards or specific laparoscopic instruments.
Single-port Robot-assisted	The procedure is performed using a single specific robotic access with or without an additional robotic/laparoscopic port.
Combined Robot-assisted/Open	It is a combined robotic/open procedure. The resection phase of the procedure is performed with a robot-assisted approach. During the reconstructive phase, at least 1 of the anastomoses is performed by a mini-laparotomy. This procedure is further classified according to the number of anastomoses performed with open approach as follows: Type I: only 1 anastomosis Type II: 2 or more anastomoses
Combined Laparoscopic/Open	It is a combined laparoscopic/open procedure. The resection phase of the procedure is performed with a laparoscopic approach. During the reconstructive phase, at least one of the anastomoses is performed by a mini-laparotomy. This procedure is further classified according to the number of anastomoses performed with the open approach as follows: Type I: only 1 anastomosis Type II: 2 or more anastomoses
Combined Roboscopic/Open	It is a combined robotic /laparoscopic/open procedure. The resection and reconstructive phase (when expected) are performed by combining the laparoscopic and/or robot-assisted with open approaches. During the reconstructive phase, at least 1 of the anastomoses is performed by a mini-laparotomy. This procedure is further classified according to the number of anastomoses performed with the open approach as follows: Type I: only 1 anastomosis Type II: 2 or more anastomoses When the surgery is completed by a laparotomy, it should be defined as “converted”.
Converted	Any minimally invasive pancreatic resection laparoscopic/robotic/roboscopic/combined that required a formal not-intended conversion to laparotomy at any stage of the procedure (resection or reconstruction) for any reasons (bleeding, vascular resection, difficult anastomosis, not-progression, etc.)

CP indicates central pancreatectomy; DP, distal pancreatectomy; PD, pancreatoduodenectomy; TP, total pancreatectomy.