{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T20:38:24Z","timestamp":1791578304726,"version":"4.3.4"},"reference-count":49,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Private Universit\u00e4t Witten\/Herdecke gGmbH"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Langenbecks Arch Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Minimally invasive pancreatoduodenectomy (MIPD) has a substantial learning curve. This systematic review and meta-analysis evaluated learning-phase effects in robotic (RPD) and laparoscopic pancreatoduodenectomy (LPD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The protocol was registered in PROSPERO (CRD420261283406). PubMed, Scopus, and Web of Science were searched through June 1, 2026. Studies reporting early-versus-late learning-phase outcomes or phase-specific RPD-versus-LPD comparisons were included. Random-effects models were used, and the certainty of evidence was assessed using GRADE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-five studies were included qualitatively and 20 quantitatively, comprising 4,764 patients. The median case volume required to overcome the learning curve was similar for RPD and LPD (31.5 vs. 35 cases;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.56). Late-phase MIPD was associated with significantly shorter operative time, lower estimated blood loss, lower conversion rate, shorter length of stay, and reduced rates of POPF, bile leak, and delayed gastric emptying. During the early phase, RPD had a longer operative time but a shorter length of stay and a lower CR-POPF than LPD. In the late phase, RPD showed lower conversion, while most other outcomes were comparable.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both RPD and LPD improve with experience. RPD may offer selected learning-phase advantages, but current evidence does not support broad superiority over LPD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00423-026-04108-0","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T22:15:22Z","timestamp":1781907322000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Robotic versus laparoscopic pancreatoduodenectomy across the learning curve: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"411","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5451-4504","authenticated-orcid":false,"given":"Ahmed","family":"Abdelsamad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0139-2873","authenticated-orcid":false,"given":"Khaled","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2787-9534","authenticated-orcid":false,"given":"Youssef","family":"Badie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9667-8504","authenticated-orcid":false,"given":"Zainab","family":"Hussein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4823-5317","authenticated-orcid":false,"given":"Mennatullah","family":"Mohsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"Selim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5395-1766","authenticated-orcid":false,"given":"Omar","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3585-4874","authenticated-orcid":false,"given":"Mohammed Khaled","family":"Mohammed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8748-6299","authenticated-orcid":false,"given":"Zeyad M.","family":"Wesh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Nickel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sascha","family":"Vaghiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Gebauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"issue":"2","key":"4108_CR1","doi-asserted-by":"publisher","first-page":"192","DOI":"10.14701\/ahbps.26-007","volume":"30","author":"GD Tebala","year":"2026","unstructured":"Tebala GD et al (2026) Single-loop versus double-loop reconstruction after pancreatoduodenectomy: Does it impact on the risk of postoperative pancreatic fistula? Ann Hepatobiliary Pancreat Surg 30(2):192\u2013202. https:\/\/doi.org\/10.14701\/ahbps.26-007","journal-title":"Ann Hepatobiliary Pancreat Surg"},{"key":"4108_CR2","doi-asserted-by":"publisher","unstructured":"Herzog T et al (2026) Hepaticojejunostomy Insufficiency-Associated Arterial Hemorrhage in Patients After Pancreatic Surgery. J Clin Med 15(8). https:\/\/doi.org\/10.3390\/jcm15082900","DOI":"10.3390\/jcm15082900"},{"key":"4108_CR3","doi-asserted-by":"publisher","unstructured":"Kendrick ML et al (2017) Minimally invasive pancreatoduodenectomy. HPB 19(3):215\u2013224. https:\/\/doi.org\/10.1016\/j.hpb.2017.01.023","DOI":"10.1016\/j.hpb.2017.01.023"},{"key":"4108_CR4","doi-asserted-by":"publisher","unstructured":"Zong K, Luo K, Chen K, Ye J, Liu W, Zhai W (2022) A comparative study of robotics and laparoscopic in minimally invasive pancreatoduodenectomy: A single-center experience. Front Oncol 12. https:\/\/doi.org\/10.3389\/fonc.2022.960241","DOI":"10.3389\/fonc.2022.960241"},{"key":"4108_CR5","unstructured":"Asbun HJ et al (2020) The Miami International Evidence-based Guidelines on Minimally Invasive Pancreas Resection. Ann Surg 271(1) [Online]. Available: https:\/\/journals.lww.com\/annalsofsurgery\/fulltext\/2020\/01000\/the_miami_international_evidence_based_guidelines.1.aspx"},{"key":"4108_CR6","doi-asserted-by":"publisher","unstructured":"Abu Hilal M et al (2024) The brescia internationally validated european guidelines on minimally invasive pancreatic surgery (EGUMIPS), Wolters Kluwer Health. https:\/\/doi.org\/10.1097\/SLA.0000000000006006","DOI":"10.1097\/SLA.0000000000006006"},{"issue":"1","key":"4108_CR7","doi-asserted-by":"publisher","first-page":"89","DOI":"10.21037\/hbsn-23-132","volume":"13","author":"R Liu","year":"2024","unstructured":"Liu R et al (2024) International consensus guidelines on robotic pancreatic surgery in 2023. Hepatobiliary Surg Nutr 13(1):89\u2013104. https:\/\/doi.org\/10.21037\/hbsn-23-132","journal-title":"Hepatobiliary Surg Nutr"},{"issue":"12","key":"4108_CR8","doi-asserted-by":"publisher","first-page":"9591","DOI":"10.1007\/s00464-023-10426-x","volume":"37","author":"FN McCarron","year":"2023","unstructured":"McCarron FN et al (2023) Expanding the utility of robotics for pancreaticoduodenectomy: a 10-year review and comparison to international benchmarks in pancreatic surgery. Surg Endosc 37(12):9591\u20139600. https:\/\/doi.org\/10.1007\/s00464-023-10426-x","journal-title":"Surg Endosc"},{"key":"4108_CR9","doi-asserted-by":"publisher","unstructured":"Dai M et al (2024) Learning curve of robotic pancreatoduodenectomy by a single surgeon with extensive laparoscopic pancreatoduodenectomy experience. J Robot Surg 18(1). https:\/\/doi.org\/10.1007\/s11701-024-02007-4","DOI":"10.1007\/s11701-024-02007-4"},{"key":"4108_CR10","unstructured":"Zwart MJW et al (2022) Outcomes of a multicenter training program in robotic pancreatoduodenectomy (LAELAPS-3). Ann Surg 276(6) [Online]. Available: https:\/\/journals.lww.com\/annalsofsurgery\/fulltext\/2022\/12000\/outcomes_of_a_multicenter_training_program_in.53.aspx"},{"key":"4108_CR11","doi-asserted-by":"publisher","unstructured":"Preukschas AA et al (2025) Training and learning curves in robotic pancreatic surgery. Clin Surg Oncol 4(2):100081. https:\/\/doi.org\/10.1016\/j.cson.2025.100081","DOI":"10.1016\/j.cson.2025.100081"},{"key":"4108_CR12","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","author":"M J Page","year":"2021","unstructured":"J Page M et al (2021) The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ Publishing Group. https:\/\/doi.org\/10.1136\/bmj.n71","journal-title":"BMJ Publishing Group"},{"key":"4108_CR13","unstructured":"Book Series C, Higgins JP, Green S Cochrane Handbook for Systematic Reviews of Interventions THE COCHRANE COLLABORATION \u00ae."},{"key":"4108_CR14","doi-asserted-by":"publisher","unstructured":"Shea BJ et al (2017) AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ (Online) 358. https:\/\/doi.org\/10.1136\/bmj.j4008","DOI":"10.1136\/bmj.j4008"},{"key":"4108_CR15","doi-asserted-by":"publisher","unstructured":"Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. https:\/\/doi.org\/10.1097\/01.sla.0000133083.54934.ae","DOI":"10.1097\/01.sla.0000133083.54934.ae"},{"key":"4108_CR16","doi-asserted-by":"publisher","unstructured":"Bassi C et al The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After, 2017, Elsevier Inc. https:\/\/doi.org\/10.1016\/j.surg.2016.11.014","DOI":"10.1016\/j.surg.2016.11.014"},{"issue":"1","key":"4108_CR17","doi-asserted-by":"publisher","first-page":"e111","DOI":"10.1097\/as9.0000000000000111","volume":"3","author":"PC M\u00fcller","year":"2022","unstructured":"M\u00fcller PC et al (2022) Learning Curves in Open, Laparoscopic, and Robotic Pancreatic Surgery. Annals Surg Open 3(1):e111. https:\/\/doi.org\/10.1097\/as9.0000000000000111","journal-title":"Annals Surg Open"},{"key":"4108_CR18","doi-asserted-by":"publisher","unstructured":"Abbas A, Hefnawy MT, Negida A (2024) Meta-analysis accelerator: a comprehensive tool for statistical data conversion in systematic reviews with meta-analysis. BMC Med Res Methodol 24(1). https:\/\/doi.org\/10.1186\/s12874-024-02356-6","DOI":"10.1186\/s12874-024-02356-6"},{"key":"4108_CR19","doi-asserted-by":"publisher","unstructured":"Gualdi-Russo E, Zaccagni L (2026) The Newcastle\u2013Ottawa scale for assessing the quality of studies in systematic reviews. Publications 14(1). https:\/\/doi.org\/10.3390\/publications14010004","DOI":"10.3390\/publications14010004"},{"key":"4108_CR20","doi-asserted-by":"publisher","unstructured":"Sterne JAC et al (2019) RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ 366. https:\/\/doi.org\/10.1136\/bmj.l4898","DOI":"10.1136\/bmj.l4898"},{"issue":"760","key":"4108_CR21","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","volume":"336","author":"GH Guyatt","year":"2008","unstructured":"Guyatt GH et al (2008) GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336(760):924\u2013926","journal-title":"BMJ"},{"issue":"12","key":"4108_CR22","doi-asserted-by":"publisher","first-page":"1282","DOI":"10.1002\/sim.3602","volume":"29","author":"D Jackson","year":"2010","unstructured":"Jackson D, White IR, Thompson SG (2010) Extending DerSimonian and Laird\u2019s methodology to perform multivariate random effects meta-analyses. Stat Med 29(12):1282\u20131297. https:\/\/doi.org\/10.1002\/sim.3602","journal-title":"Stat Med"},{"key":"4108_CR23","doi-asserted-by":"publisher","unstructured":"Woolson RF (2008) Wilcoxon Signed-Rank Test, in Wiley Encyclopedia of Clinical Trials, pp. 1\u20133. https:\/\/doi.org\/10.1002\/9780471462422.eoct979","DOI":"10.1002\/9780471462422.eoct979"},{"issue":"3","key":"4108_CR24","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1002\/jhbp.1078","volume":"29","author":"H Kim","year":"2022","unstructured":"Kim H, Choi SH, Jang JY, Choi M, Lee JH, Kang CM (2022) Multicenter comparison of totally laparoscopic and totally robotic pancreaticoduodenectomy: Propensity score and learning curve-matching analyses. J Hepatobiliary Pancreat Sci 29(3):311\u2013321. https:\/\/doi.org\/10.1002\/jhbp.1078","journal-title":"J Hepatobiliary Pancreat Sci"},{"issue":"5","key":"4108_CR25","doi-asserted-by":"publisher","first-page":"484","DOI":"10.5582\/bst.2018.01236","volume":"12","author":"Y Zhang","year":"2018","unstructured":"Zhang Y, Hong D, Zhang C, Hu Z (2018) Total laparoscopic versus robot-assisted laparoscopic pancreaticoduodenectomy. Biosci Trends 12(5):484\u2013490. https:\/\/doi.org\/10.5582\/bst.2018.01236","journal-title":"Biosci Trends"},{"issue":"6","key":"4108_CR26","doi-asserted-by":"publisher","first-page":"3681","DOI":"10.1007\/s00464-025-11684-7","volume":"39","author":"L Chen","year":"2025","unstructured":"Chen L et al (2025) Outcomes evaluation of robotic versus laparoscopic pancreaticoduodenectomy: a propensity score matching and learning curve analysis. Surg Endosc 39(6):3681\u20133690. https:\/\/doi.org\/10.1007\/s00464-025-11684-7","journal-title":"Surg Endosc"},{"issue":"5","key":"4108_CR27","doi-asserted-by":"publisher","first-page":"2602","DOI":"10.1007\/s00464-024-10783-1","volume":"38","author":"CJ Wehrle","year":"2024","unstructured":"Wehrle CJ et al (2024) Comparing oncologic and surgical outcomes of robotic and laparoscopic pancreatoduodenectomy in patients with pancreatic cancer: a propensity-matched analysis. Surg Endosc 38(5):2602\u20132610. https:\/\/doi.org\/10.1007\/s00464-024-10783-1","journal-title":"Surg Endosc"},{"issue":"9","key":"4108_CR28","doi-asserted-by":"publisher","first-page":"2927","DOI":"10.1007\/s00464-018-6595-0","volume":"33","author":"T Zhang","year":"2019","unstructured":"Zhang T, Zhao ZM, Gao YX, Lau WY, Liu R (2019) The learning curve for a surgeon in robot-assisted laparoscopic pancreaticoduodenectomy: a retrospective study in a high-volume pancreatic center. Surg Endosc 33(9):2927\u20132933. https:\/\/doi.org\/10.1007\/s00464-018-6595-0","journal-title":"Surg Endosc"},{"key":"4108_CR29","doi-asserted-by":"publisher","unstructured":"Chao YJ et al (2023) Feasibility of simultaneous development of laparoscopic and robotic pancreaticoduodenectomy. Sci Rep 13(1). https:\/\/doi.org\/10.1038\/s41598-023-33269-x","DOI":"10.1038\/s41598-023-33269-x"},{"issue":"2","key":"4108_CR30","doi-asserted-by":"publisher","first-page":"1515","DOI":"10.1007\/s00464-021-08439-5","volume":"36","author":"P Tyutyunnik","year":"2022","unstructured":"Tyutyunnik P et al (2022) Learning curve of three European centers in laparoscopic, hybrid laparoscopic, and robotic pancreatoduodenectomy. Surg Endosc 36(2):1515\u20131526. https:\/\/doi.org\/10.1007\/s00464-021-08439-5","journal-title":"Surg Endosc"},{"key":"4108_CR31","doi-asserted-by":"publisher","unstructured":"W. Taylor Martin et al (2024) Learning Curve of a Laparoscopic Pancreaticoduodenectomy Program at a Second Institution. Am Surg 90(6):1582\u20131590. https:\/\/doi.org\/10.1177\/00031348241246163","DOI":"10.1177\/00031348241246163"},{"key":"4108_CR32","unstructured":"Zhang X-P et al (2025) Outcomes of robotic versus laparoscopic pancreatoduodenectomy after learning curves of surgeons: A multicenter study on 2255 Patients. Ann Surg 281(2) [Online]. Available: https:\/\/journals.lww.com\/annalsofsurgery\/fulltext\/2025\/02000\/outcomes_of_robotic_versus_laparoscopic.25.aspx"},{"key":"4108_CR33","doi-asserted-by":"publisher","first-page":"4357","DOI":"10.12998\/wjcc.v10.i14.4357","volume":"10","author":"ZG Wei","year":"2022","unstructured":"Wei ZG, Liang CJ, Du Y, Zhang YP, Liu Y (2022) Learning curve for a surgeon in robotic pancreaticoduodenectomy through a \u2018G\u2019-shaped approach: A cumulative sum analysis. World J Clin Cases 10:4357\u20134367. https:\/\/doi.org\/10.12998\/wjcc.v10.i14.4357","journal-title":"World J Clin Cases"},{"issue":"4","key":"4108_CR34","doi-asserted-by":"publisher","first-page":"2659","DOI":"10.1007\/s00464-022-09735-4","volume":"37","author":"AMLH Emmen","year":"2023","unstructured":"Emmen AMLH et al (2023) Impact of shifting from laparoscopic to robotic surgery during 600 minimally invasive pancreatic and liver resections. Surg Endosc 37(4):2659\u20132672. https:\/\/doi.org\/10.1007\/s00464-022-09735-4","journal-title":"Surg Endosc"},{"key":"4108_CR35","doi-asserted-by":"publisher","unstructured":"DeLaura I et al (2024) Defining the learning curve for robotic pancreaticoduodenectomy for a single surgeon following experience with laparoscopic pancreaticoduodenectomy. J Robot Surg 18:1. https:\/\/doi.org\/10.1007\/s11701-023-01746-0","DOI":"10.1007\/s11701-023-01746-0"},{"issue":"0","key":"4108_CR36","doi-asserted-by":"publisher","first-page":"0","DOI":"10.21037\/hbsn-24-547","volume":"0","author":"A-Q Fu","year":"2023","unstructured":"Fu A-Q et al (2023) Factors associated with textbook outcome after robotic-assisted pancreatoduodenectomy: a single surgeon\u2019s retrospective cohort. Hepatobiliary Surg Nutr 0(0):0\u20130. https:\/\/doi.org\/10.21037\/hbsn-24-547","journal-title":"Hepatobiliary Surg Nutr"},{"issue":"5","key":"4108_CR37","doi-asserted-by":"publisher","first-page":"766","DOI":"10.21037\/hbsn-2024-706","volume":"14","author":"S Xu","year":"2025","unstructured":"Xu S et al (2025) Laparoscopic versus robotic pancreaticoduodenectomy for distal cholangiocarcinoma after learning curves of surgeons: a multicenter propensity score-matched study. Hepatobiliary Surg Nutr 14(5):766\u2013781. https:\/\/doi.org\/10.21037\/hbsn-2024-706","journal-title":"Hepatobiliary Surg Nutr"},{"issue":"6","key":"4108_CR38","doi-asserted-by":"publisher","first-page":"937","DOI":"10.21037\/hbsn-2024-723","volume":"14","author":"A Castel","year":"2025","unstructured":"Castel A et al (2025) Safety and learning curve of robotic pancreatoduodenectomy with limited robotic platform access: a propensity score-matched comparison with open surgery in a high-volume center. Hepatobiliary Surg Nutr 14(6):937\u2013948. https:\/\/doi.org\/10.21037\/hbsn-2024-723","journal-title":"Hepatobiliary Surg Nutr"},{"issue":"6","key":"4108_CR39","doi-asserted-by":"publisher","first-page":"E1277","DOI":"10.1097\/SLA.0000000000003664","volume":"274","author":"Y Shi","year":"2021","unstructured":"Shi Y et al (2021) Learning Curve from 450 Cases of Robot-Assisted Pancreaticoduocectomy in a High-Volume Pancreatic Center Optimization of Operative Procedure and a Retrospective Study. Ann Surg 274(6):E1277\u2013E1283. https:\/\/doi.org\/10.1097\/SLA.0000000000003664","journal-title":"Ann Surg"},{"issue":"11","key":"4108_CR40","doi-asserted-by":"publisher","first-page":"1637","DOI":"10.1016\/j.hpb.2020.03.008","volume":"22","author":"TM Gall","year":"2020","unstructured":"Gall TM, Pencavel TD, Cunningham D, Nicol D, Jiao LR (2020) Transition from open and laparoscopic to robotic pancreaticoduodenectomy in a UK tertiary referral hepatobiliary and pancreatic centre - Early experience of robotic pancreaticoduodenectomy. HPB 22(11):1637\u20131644. https:\/\/doi.org\/10.1016\/j.hpb.2020.03.008","journal-title":"HPB"},{"issue":"4","key":"4108_CR41","doi-asserted-by":"publisher","first-page":"508","DOI":"10.14701\/ahbps.24-121","volume":"28","author":"JS Kang","year":"2024","unstructured":"Kang JS et al (2024) Perioperative outcomes of robot-assisted pancreatoduodenectomy (PD) and totally laparoscopic PD after overcoming learning curves with comparison of oncologic outcomes between open PD and minimally invasive PD. Ann Hepatobiliary Pancreat Surg 28(4):508\u2013515. https:\/\/doi.org\/10.14701\/ahbps.24-121","journal-title":"Ann Hepatobiliary Pancreat Surg"},{"issue":"4","key":"4108_CR42","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1159\/000445015","volume":"33","author":"N Napoli","year":"2016","unstructured":"Napoli N et al (2016) The Learning Curve in Robotic Pancreaticoduodenectomy. Dig Surg 33(4):299\u2013307. https:\/\/doi.org\/10.1159\/000445015","journal-title":"Dig Surg"},{"key":"4108_CR43","doi-asserted-by":"crossref","unstructured":"Marino MV, Podda M, Pisanu A, di Saverio S, Fleitas MG, Stefano Pellegrino V (2020) Robotic-assisted pancreaticoduodenectomy: Technique description and performance evaluation after 60 Cases. [Online]. Available: https:\/\/www.surgical-laparoscopy.com","DOI":"10.1097\/SLE.0000000000000751"},{"key":"4108_CR44","doi-asserted-by":"publisher","unstructured":"Shyr BU, Chen SC, Shyr YM, Wang SE (2018) Learning curves for robotic pancreatic surgery-from distal pancreatectomy to pancreaticoduodenectomy. Med (United States) 97(45). https:\/\/doi.org\/10.1097\/MD.0000000000013000","DOI":"10.1097\/MD.0000000000013000"},{"issue":"9","key":"4108_CR45","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1093\/bjs\/znad045","volume":"110","author":"F Nickel","year":"2023","unstructured":"Nickel F et al (2023) Initial learning curves of laparoscopic and robotic distal pancreatectomy compared with open distal pancreatectomy: multicentre analysis. Br J Surg 110(9):1063\u20131067. https:\/\/doi.org\/10.1093\/bjs\/znad045","journal-title":"Br J Surg"},{"key":"4108_CR46","doi-asserted-by":"publisher","unstructured":"Wang H et al (2024) The learning curve for laparoscopic pancreaticoduodenectomy by a proficient laparoscopic surgeon: a retrospective study at a single center. BMC Surg 24(1). https:\/\/doi.org\/10.1186\/s12893-023-02270-6","DOI":"10.1186\/s12893-023-02270-6"},{"key":"4108_CR47","doi-asserted-by":"publisher","unstructured":"Delvecchio A et al (2025) Step-by-step description of standardized technique for robotic pancreatoduodenectomy. Curr Oncol 32(6). https:\/\/doi.org\/10.3390\/curroncol32060302","DOI":"10.3390\/curroncol32060302"},{"key":"4108_CR48","doi-asserted-by":"publisher","unstructured":"I. C. on M. I. P. S. (I-MIPS) et al (2024) Learning curve stratified outcomes after robotic pancreatoduodenectomy: International multicenter experience. Surgery 176(6):1721\u20131729. https:\/\/doi.org\/10.1016\/j.surg.2024.05.044","DOI":"10.1016\/j.surg.2024.05.044"},{"key":"4108_CR49","doi-asserted-by":"publisher","unstructured":"Jones LR et al (2024) Learning curve stratified outcomes after robotic pancreatoduodenectomy: International multicenter experience. Surgery (United States) 176(6):1721\u20131729. https:\/\/doi.org\/10.1016\/j.surg.2024","DOI":"10.1016\/j.surg.2024"}],"container-title":["Langenbeck's Archives of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00423-026-04108-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00423-026-04108-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00423-026-04108-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T04:58:19Z","timestamp":1782104299000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00423-026-04108-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,19]]},"references-count":49,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4108"],"URL":"https:\/\/doi.org\/10.1007\/s00423-026-04108-0","relation":{},"ISSN":["1435-2451"],"issn-type":[{"value":"1435-2451","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,19]]},"assertion":[{"value":"15 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"171"}}