{
  "abstract": "Objective\n\nTo assess the feasibility of and clinical outcomes after a pan-European training program for robotic pancreatoduodenectomy (RPD).Summary background data\n\nThe implementation of RPD into clinical practice comes with considerable challenges, leading to concerns about patient safety, oncological outcomes, and costs. To address this, a structured training program was implemented in which 2 surgeons at each of the 20 sites were trained and maintained as a consistent operative team.Study design\n\nA structured training program for RPD was implemented, and outcomes were prospectively collected in 20 European high-volume centers, all without previous RPD experience, from 12 countries. The program included a video library, biotissue simulation (pancreaticojejunostomy and hepaticojejunostomy), off-site RPD case observations, and on-site proctoring. Surgeons' simulation anastomoses were assessed using Objective Structured Assessment of Technical Skills (OSATS) and technical errors. The primary endpoint was intra- and postoperative patient outcome. A key secondary analysis assessed safety using OSATS scores and error counts during the biotissue training..Results\n\nOverall, 486 RPD procedures were performed. Median intraoperative blood loss was 200 mL (IQR: 100-400), operative time was 475 minutes (IQR: 414-553.3), and the conversion rate was 18.3% (n=89). The rate of Clavien-Dindo grade ≥III complications was 31.4% (n=153), POPF was 21.2% (n=103), delayed gastric emptying was 15% (n=73), postpancreatectomy hemorrhage was 8.6% (n=42), and in-hospital/30-day mortality was 2.7% (n=13). Median length of stay was 12 days (IQR: 8-20). During simulation training, OSATS scores significantly improved (0.350 points/attempt ( ρ ), P <0.001) while the duration of reconstruction decreased ( P <0.001). There was a significant decrease of the total number of errors made during consecutive attempts in the biotissue training (0.175 errors decrease per attempt, P =0.006]).Conclusions\n\nWe report on the first successfully completed international training program for RPD. Simulation established a standardized technical competency, although a learning-curve effect (POPF) remained detectable per center. These data highlight that safe adoption of complex procedures requires structured, team-based, proctored training beyond simulation alone.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Surgery, Amsterdam UMC, location University of Amsterdam, The Netherlands.",
    "Cancer Center Amsterdam, The Netherlands.",
    "Department of General Surgery, Instituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.",
    "Department of Surgery, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.",
    "Department of Surgery, Amsterdam UMC, location Vrije Universiteit, The Netherlands.",
    "Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.",
    "Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.",
    "Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.",
    "Department of Digestive and Endocrine Surgery, University Hospital of Orléans, Orléans, France.",
    "Department of Surgery, OLVG, Amsterdam, The Netherlands.",
    "Department of Surgery, Rigshospitalet, Copenhagen, Denmark.",
    "Department of Clinical Science, Intervention and Technology, Department Division of Surgery and Oncology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.",
    "Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.",
    "Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.",
    "Department of Surgery, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.",
    "Department of Surgery, University Hospital Münster, Münster, Germany.",
    "Department of Surgery, Skane University Hospital, Lund, Sweden.",
    "Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.",
    "Department of Surgery, Klinikum Dortmund, University of Witten/Herdecke, Dortmund, Germany.",
    "Department of General Surgery, Koc University School of Medicine, Istanbul, Turkey.",
    "Department of Surgery, Niguarda Hospital, Milan, Italy.",
    "Department of Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.",
    "Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.",
    "Department of Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.",
    "Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.",
    "Department of Surgery, Royal Surrey NHS Foundation Trust, Guildford, UK.",
    "Department of Surgery, Olomouc University Hospital, Olomouc, Czech Republic.",
    "Department of Surgery, Royal Liverpool University Hospital NHS Foundation Trust, Liverpool, UK.",
    "Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.",
    "Department of Surgery, Ghent University Hospital, Ghent, Belgium.",
    "Department of Surgery, Northshore University Health System, Chicago, IL.",
    "Department of Surgery, School of Medicine, The University of Jordan, Amman, Jordan.",
    "Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 38,
  "authors": [
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Leia R Jones",
      "orcid": "0000-0001-6286-5155"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Maurice J W Zwart"
    },
    {
      "affs": [
        3
      ],
      "name": "Felix Nickel"
    },
    {
      "affs": [
        3
      ],
      "name": "Thilo Hackert"
    },
    {
      "affs": [
        1,
        4
      ],
      "name": "Freek Daams"
    },
    {
      "affs": [
        5
      ],
      "name": "Bas Groot Koerkamp"
    },
    {
      "affs": [
        6
      ],
      "name": "Quintus Molenaar"
    },
    {
      "affs": [
        7
      ],
      "name": "Ugo Boggi"
    },
    {
      "affs": [
        8
      ],
      "name": "Olivier Saint-Marc"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Philip Leenart"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Rawin Amiri"
    },
    {
      "affs": [
        1,
        4
      ],
      "name": "Mahsoem Ali"
    },
    {
      "affs": [
        9
      ],
      "name": "Sebastiaan Festen"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Olivier Busch"
    },
    {
      "affs": [
        10
      ],
      "name": "Paul S Krohn"
    },
    {
      "affs": [
        11
      ],
      "name": "Ernesto Sparrelid"
    },
    {
      "affs": [
        12
      ],
      "name": "Bergthor Björnsson"
    },
    {
      "affs": [
        13
      ],
      "name": "Christian Toso"
    },
    {
      "affs": [
        14
      ],
      "name": "Edoardo Rosso"
    },
    {
      "affs": [
        15
      ],
      "name": "Benjamin Strücker"
    },
    {
      "affs": [
        16
      ],
      "name": "Peter Strandberg-Holka"
    },
    {
      "affs": [
        17
      ],
      "name": "Maxime Dewulf"
    },
    {
      "affs": [
        18
      ],
      "name": "Maximilian Schmeding"
    },
    {
      "affs": [
        19
      ],
      "name": "Emre Bozkurt"
    },
    {
      "affs": [
        20
      ],
      "name": "Giovanni Ferrari"
    },
    {
      "affs": [
        21
      ],
      "name": "Steve White"
    },
    {
      "affs": [
        22
      ],
      "name": "Emanuel Vigia"
    },
    {
      "affs": [
        23
      ],
      "name": "Zahir Soonawalla"
    },
    {
      "affs": [
        24
      ],
      "name": "Martijn Stommel"
    },
    {
      "affs": [
        25
      ],
      "name": "Tim Pencavel"
    },
    {
      "affs": [
        26
      ],
      "name": "Martin Lovecek"
    },
    {
      "affs": [
        27
      ],
      "name": "Declan Dunne"
    },
    {
      "affs": [
        28
      ],
      "name": "Giovanni Marchegiani"
    },
    {
      "affs": [
        29
      ],
      "name": "Filip Gryspeerdt"
    },
    {
      "affs": [
        30
      ],
      "name": "Melissa E Hogg"
    },
    {
      "affs": [
        31,
        32
      ],
      "name": "Mohammad Abu Hilal"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Marc G Besselink"
    },
    {
      "name": "European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/cqv8cqrawcnk8.bib",
  "cited_by": 0,
  "doi": "10.1097/sla.0000000000007170",
  "fulltext_url": "https://europepmc.org/articles/PMC13652116",
  "id": "cqv8cqrawcnk8",
  "issns": [
    "0003-4932",
    "1528-1140"
  ],
  "landing_url": "https://europepmc.org/article/MED/42839322",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Surgical Simulation and Training"
    ]
  ],
  "openalex": "W7220854782",
  "pdf_url": "https://europepmc.org/articles/PMC13652116?pdf=render",
  "pmcid": "PMC13652116",
  "pmid": "42839322",
  "published": "2026-10-07",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/cqv8cqrawcnk8.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:02Z",
      "native_id": "MED:42839322",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42839322"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Surgical Simulation and Training",
      "subfield": "surgery"
    }
  ],
  "title": "Pan-European Training Program for Robotic Pancreatoduodenectomy (LEARNBOT): Prospective Multicenter Study on Feasibility and Outcome.",
  "title_text": "Pan-European Training Program for Robotic Pancreatoduodenectomy (LEARNBOT): Prospective Multicenter Study on Feasibility and Outcome.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:18:02Z",
  "url": "https://research.draconitic.com/paper/cqv8cqrawcnk8",
  "venue": "Annals of surgery",
  "versions": []
}