Pan-European Training Program for Robotic Pancreatoduodenectomy (LEARNBOT): Prospective Multicenter Study on Feasibility and Outcome.
33 affiliations
- 1Department of Surgery, Amsterdam UMC, location University of Amsterdam, The Netherlands.
- 2Cancer Center Amsterdam, The Netherlands.
- 3Department of General Surgery, Instituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
- 4Department of Surgery, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
- 5Department of Surgery, Amsterdam UMC, location Vrije Universiteit, The Netherlands.
- 6Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
- 7Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
- 8Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
- 9Department of Digestive and Endocrine Surgery, University Hospital of Orléans, Orléans, France.
- 10Department of Surgery, OLVG, Amsterdam, The Netherlands.
- 11Department of Surgery, Rigshospitalet, Copenhagen, Denmark.
- 12Department of Clinical Science, Intervention and Technology, Department Division of Surgery and Oncology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
- 13Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- 14Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
- 15Department of Surgery, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.
- 16Department of Surgery, University Hospital Münster, Münster, Germany.
- 17Department of Surgery, Skane University Hospital, Lund, Sweden.
- 18Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
- 19Department of Surgery, Klinikum Dortmund, University of Witten/Herdecke, Dortmund, Germany.
- 20Department of General Surgery, Koc University School of Medicine, Istanbul, Turkey.
- 21Department of Surgery, Niguarda Hospital, Milan, Italy.
- 22Department of Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
- 23Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
- 24Department of Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- 25Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
- 26Department of Surgery, Royal Surrey NHS Foundation Trust, Guildford, UK.
- 27Department of Surgery, Olomouc University Hospital, Olomouc, Czech Republic.
- 28Department of Surgery, Royal Liverpool University Hospital NHS Foundation Trust, Liverpool, UK.
- 29Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
- 30Department of Surgery, Ghent University Hospital, Ghent, Belgium.
- 31Department of Surgery, Northshore University Health System, Chicago, IL.
- 32Department of Surgery, School of Medicine, The University of Jordan, Amman, Jordan.
- 33Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Abstract
Objective
To assess the feasibility of and clinical outcomes after a pan-European training program for robotic pancreatoduodenectomy (RPD).Summary background data
The 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
A 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
Overall, 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
We 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.
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BibTeX
@article{jones2026paneuropean,
title = {{Pan-European Training Program for Robotic Pancreatoduodenectomy (LEARNBOT): Prospective Multicenter Study on Feasibility and Outcome.}},
author = {Leia R Jones and Maurice J W Zwart and Felix Nickel and Thilo Hackert and Freek Daams and Bas Groot Koerkamp and Quintus Molenaar and Ugo Boggi and Olivier Saint-Marc and Philip Leenart and Rawin Amiri and Mahsoem Ali and Sebastiaan Festen and Olivier Busch and Paul S Krohn and Ernesto Sparrelid and Bergthor Björnsson and Christian Toso and Edoardo Rosso and Benjamin Strücker and Peter Strandberg-Holka and Maxime Dewulf and Maximilian Schmeding and Emre Bozkurt and Giovanni Ferrari and Steve White and Emanuel Vigia and Zahir Soonawalla and Martijn Stommel and Tim Pencavel and Martin Lovecek and Declan Dunne and Giovanni Marchegiani and Filip Gryspeerdt and Melissa E Hogg and Mohammad Abu Hilal and Marc G Besselink and European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)},
journal = {Annals of surgery},
year = {2026},
month = oct,
doi = {10.1097/sla.0000000000007170},
url = {https://europepmc.org/article/MED/42839322},
note = {CC BY},
}
RIS
TY - JOUR
TI - Pan-European Training Program for Robotic Pancreatoduodenectomy (LEARNBOT): Prospective Multicenter Study on Feasibility and Outcome.
AU - Leia R Jones
AU - Maurice J W Zwart
AU - Felix Nickel
AU - Thilo Hackert
AU - Freek Daams
AU - Bas Groot Koerkamp
AU - Quintus Molenaar
AU - Ugo Boggi
AU - Olivier Saint-Marc
AU - Philip Leenart
AU - Rawin Amiri
AU - Mahsoem Ali
AU - Sebastiaan Festen
AU - Olivier Busch
AU - Paul S Krohn
AU - Ernesto Sparrelid
AU - Bergthor Björnsson
AU - Christian Toso
AU - Edoardo Rosso
AU - Benjamin Strücker
AU - Peter Strandberg-Holka
AU - Maxime Dewulf
AU - Maximilian Schmeding
AU - Emre Bozkurt
AU - Giovanni Ferrari
AU - Steve White
AU - Emanuel Vigia
AU - Zahir Soonawalla
AU - Martijn Stommel
AU - Tim Pencavel
AU - Martin Lovecek
AU - Declan Dunne
AU - Giovanni Marchegiani
AU - Filip Gryspeerdt
AU - Melissa E Hogg
AU - Mohammad Abu Hilal
AU - Marc G Besselink
AU - European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)
PY - 2026
DA - 2026/10/07
JO - Annals of surgery
DO - 10.1097/sla.0000000000007170
UR - https://europepmc.org/article/MED/42839322
AB - Objective To assess the feasibility of and clinical outcomes after a pan-European training program for robotic pancreatoduodenectomy (RPD).Summary background data The 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 A 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 Overall, 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 We 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.
SN - 0003-4932
SN - 1528-1140
ER -