Background: Pancreaticoduodenectomy (PD) with portal–superior mesenteric vein (PV-SMV) resection is increasingly performed in borderline-resectable periampullary cancer. While conventional PD is the reference standard, robotic PD (RPD) may improve operative ergonomics and recovery; its performance and learning curve in PV-SMV resection remain unclear. Materials and Methods: We retrospectively reviewed consecutive patients undergoing PD with PV-SMV resection at a single tertiary center by a single surgeon (July 2016–September 2022). Twenty-seven patients met the inclusion criteria and were grouped as conventional PD (n = 14) or RPD (n = 13). To assess the learning curve, RPD cases were stratified as early (cases 1–3) versus late (cases 4–13). Primary outcomes were operative time and blood loss; secondary outcomes included 90-day morbidity/mortality, R0 margin, lymph node yield, length of stay, readmission, and overall survival. Results: Baseline characteristics were comparable between conventional PD and RPD. Median operative time was longer with RPD vs. conventional PD (624.0 [IQR 579.0–794.0] vs. 529.5 [456.5–636.5] mins; p = 0.024). Median blood loss trended lower with RPD (350.0 [200.0–1950.0] vs. 1455.0 [630.0–2940.0] mL; p = 0.254). Rates of clinically relevant complications (including POPF, DGE, and hemorrhage), R0 resection (69% vs. 64%), lymph node retrieval, length of stay, 90-day readmission, 90-day mortality, and overall survival were similar between conventional PD and RPD. Within RPD, operative time and blood loss improved from the early to late phases (794.0 → 601.5 min; 1950.0 → 275.0 mL), consistent with a learning-curve effect, though not statistically significant in this small cohort. Conclusions: In selected patients, RPD with PV-SMV resection is feasible and achieves oncologic and short-term clinical outcomes comparable to conventional PD, with evidence of efficiency gains as experience accrues. These findings support structured training and case accumulation for the safe adoption of complex robotic pancreatic surgery.

Background/Objectives: Intra-abdominal infections (IAIs) constitute significant clinical challenges that can rapidly progress to life-threatening conditions if not promptly diagnosed and treated. Traditional pathogen identification methodologies, predominantly culture-based, frequently necessitate extended turnaround times (TATs) and exhibit limitations in detecting polymicrobial or anaerobic infections. Methods: We implemented Oxford Nanopore Technology (ONT) sequencing to analyze the microbiota in patients with IAIs at Taichung Veterans General Hospital. The study cohort comprised sixteen patients with IAIs. Following specimen collection, DNA extraction was performed, and then full-length 16S rRNA and ITS region amplification and subsequent ONT sequencing were conducted. Results: Conventional clinical culture-based methodologies detected pathogens in 13 patients. Among the 14 successfully sequenced specimens, ONT sequencing elucidated a diverse spectrum of bacteria and fungi, with read counts ranging from 375 to 19,716. Polymicrobial and anaerobe-enriched communities were predominantly observed in lower gastrointestinal tract infections, specifically colonic or small bowel perforations, whereas upper gastrointestinal perforations, including those of the stomach or duodenum, were frequently dominated by Streptococcus, Granulicatella, or Candida species. The sequencing identified pathogens concordant with culture results, including Escherichia coli, Enterococcus, and Candida albicans. In addition, anaerobic or low-abundance taxa were exclusively identifiable through sequencing methodologies. Conclusions: ONT sequencing facilitated results within up to 24 h and successfully detected pathogens in culture-negative cases. These findings underscore the utility of ONT sequencing as an expeditious and comprehensive diagnostic modality for IAIs.