{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T04:45:30Z","timestamp":1791780330829,"version":"4.3.4"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/ http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To assess the feasibility of and clinical outcomes after a pan-European training program for robotic pancreatoduodenectomy (RPD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary Background Data:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>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\u2019 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..<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Overall, 486 RPD procedures were performed. Median intraoperative blood loss was 200\u00a0mL (IQR: 100\u2013400), operative time was 475 minutes (IQR: 414\u2013553.3), and the conversion rate was 18.3% (n=89). The rate of Clavien-Dindo grade \u2265III 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\u201320). During simulation training, OSATS scores significantly improved (0.350 points\/attempt (\n                      <jats:italic toggle=\"yes\">\u03c1<\/jats:italic>\n                      ),\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) while the duration of reconstruction decreased (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;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,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.006]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/sla.0000000000007170","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:00:23Z","timestamp":1791345623000},"page":"993-1001","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Pan-European Training Program for Robotic Pancreatoduodenectomy (LEARNBOT)"],"prefix":"10.1097","volume":"284","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6286-5155","authenticated-orcid":false,"given":"Leia R.","family":"Jones","sequence":"first","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, location University of Amsterdam, The Netherlands"},{"name":"Cancer Center Amsterdam, The Netherlands"},{"name":"Department of General Surgery, Instituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurice J.W.","family":"Zwart","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, location University of Amsterdam, The Netherlands"},{"name":"Cancer Center Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Nickel","sequence":"additional","affiliation":[{"name":"Department of Surgery, Universit\u00e4tsklinikum Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thilo","family":"Hackert","sequence":"additional","affiliation":[{"name":"Department of Surgery, Universit\u00e4tsklinikum Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Freek","family":"Daams","sequence":"additional","affiliation":[{"name":"Cancer Center Amsterdam, The Netherlands"},{"name":"Department of Surgery, Amsterdam UMC, location Vrije Universiteit, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bas","family":"Groot Koerkamp","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quintus","family":"Molenaar","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugo","family":"Boggi","sequence":"additional","affiliation":[{"name":"Division of General and Transplant Surgery, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Saint-Marc","sequence":"additional","affiliation":[{"name":"Department of Digestive and Endocrine Surgery, University Hospital of Orl\u00e9ans, Orl\u00e9ans, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Leenart","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, location University of Amsterdam, The Netherlands"},{"name":"Cancer Center Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rawin","family":"Amiri","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, location University of Amsterdam, The Netherlands"},{"name":"Cancer Center Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahsoem","family":"Ali","sequence":"additional","affiliation":[{"name":"Cancer Center Amsterdam, The Netherlands"},{"name":"Department of Surgery, Amsterdam UMC, location Vrije Universiteit, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastiaan","family":"Festen","sequence":"additional","affiliation":[{"name":"Department of Surgery, OLVG, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Busch","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, location University of Amsterdam, The Netherlands"},{"name":"Cancer Center Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul S.","family":"Krohn","sequence":"additional","affiliation":[{"name":"Department of Surgery, Rigshospitalet, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernesto","family":"Sparrelid","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Department Division of Surgery and Oncology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bergthor","family":"Bj\u00f6rnsson","sequence":"additional","affiliation":[{"name":"Department of Surgery and Department of Biomedical and Clinical Sciences, Link\u00f6ping University, Link\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Toso","sequence":"additional","affiliation":[{"name":"Department of Surgery, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Rosso","sequence":"additional","affiliation":[{"name":"Department of Surgery, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Str\u00fccker","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Strandberg-Holka","sequence":"additional","affiliation":[{"name":"Department of Surgery, Skane University Hospital, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxime","family":"Dewulf","sequence":"additional","affiliation":[{"name":"Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Schmeding","sequence":"additional","affiliation":[{"name":"Department of Surgery, Klinikum Dortmund, University of Witten\/Herdecke, Dortmund, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emre","family":"Bozkurt","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Koc University School of Medicine, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Ferrari","sequence":"additional","affiliation":[{"name":"Department of Surgery, Niguarda Hospital, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"White","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuel","family":"Vigia","sequence":"additional","affiliation":[{"name":"Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahir","family":"Soonawalla","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn","family":"Stommel","sequence":"additional","affiliation":[{"name":"Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Pencavel","sequence":"additional","affiliation":[{"name":"Department of Surgery, Royal Surrey NHS Foundation Trust, Guildford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Lovecek","sequence":"additional","affiliation":[{"name":"Department of Surgery, Olomouc University Hospital, Olomouc, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Declan","family":"Dunne","sequence":"additional","affiliation":[{"name":"Department of Surgery, Royal Liverpool University Hospital NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Marchegiani","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filip","family":"Gryspeerdt","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ghent University Hospital, Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa E.","family":"Hogg","sequence":"additional","affiliation":[{"name":"Department of Surgery, Northshore University Health System, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Abu Hilal","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine, The University of Jordan, Amman, Jordan"},{"name":"Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc G.","family":"Besselink","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, location University of Amsterdam, The 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Outcome"],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":32,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/sla.0000000000007170","relation":{},"ISSN":["0003-4932","1528-1140"],"issn-type":[{"value":"0003-4932","type":"print"},{"value":"1528-1140","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"assertion":[{"value":"2026-02-10","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-22","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}