{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T14:08:32Z","timestamp":1787580512376,"version":"build-2736575974"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"vor","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"Research funding from Intuitive Foundation","award":["2023-2905"],"award-info":[{"award-number":["2023-2905"]}]},{"name":"a nonprofit organization and R&D fund from the Center for Development of Advanced Cancer Therapy, the Cancer Institute Hospital of Japanese Foundation for Cancer Research","award":["CDACT25-01"],"award-info":[{"award-number":["CDACT25-01"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Surg"],"DOI":"10.1186\/s12893-025-03464-w","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T08:58:58Z","timestamp":1767949138000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Evaluation of safety and efficacy of robotic-assisted pancreaticoduodenectomy (SWARS study): a study protocol for a multi-center randomized phase-2 trial"],"prefix":"10.1186","volume":"26","author":[{"given":"Kosuke","family":"Kobayashi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosuke","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yui","family":"Sawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoru","family":"Abe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riki","family":"Ninomiya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryuji","family":"Yoshioka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshikuni","family":"Kawaguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihiro","family":"Mise","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriyuki","family":"Ishida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Miyazaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuyuki","family":"Takemura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akio","family":"Saiura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyoshi","family":"Hasegawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"3464_CR1","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1007\/BF00642443","volume":"8","author":"M Gagner","year":"1994","unstructured":"Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8:408\u201310.","journal-title":"Surg Endosc"},{"key":"3464_CR2","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1016\/S2468-1253(21)00054-6","volume":"6","author":"M Wang","year":"2021","unstructured":"Wang M, Li D, Chen R, et al. Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours: a multicentre, open-label, randomised controlled trial. Lancet Gastroenterol Hepatol. 2021;6:438\u201347.","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"3464_CR3","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/S2468-1253(19)30004-4","volume":"4","author":"J van Hilst","year":"2019","unstructured":"van Hilst J, de Rooij T, Bosscha K, et al. Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2\/3 trial. Lancet Gastroenterol Hepatol. 2019;4:199\u2013207.","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"3464_CR4","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1097\/SLA.0000000000002893","volume":"268","author":"I Poves","year":"2018","unstructured":"Poves I, Burd\u00edo F, Morat\u00f3 O, et al. Comparison of perioperative outcomes between laparoscopic and open approach for pancreatoduodenectomy: the PADULAP randomized controlled trial: the PADULAP randomized controlled trial. Ann Surg. 2018;268:731\u20139.","journal-title":"Ann Surg"},{"key":"3464_CR5","doi-asserted-by":"publisher","first-page":"1443","DOI":"10.1002\/bjs.10662","volume":"104","author":"C Palanivelu","year":"2017","unstructured":"Palanivelu C, Senthilnathan P, Sabnis SC, et al. Randomized clinical trial of laparoscopic versus open pancreatoduodenectomy for periampullary tumours. Br J Surg. 2017;104:1443\u201350.","journal-title":"Br J Surg"},{"key":"3464_CR6","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1001\/archsurg.138.7.777","volume":"138","author":"PC Giulianotti","year":"2003","unstructured":"Giulianotti PC, Coratti A, Angelini M, et al. Robotics in general surgery: personal experience in a large community hospital: personal experience in a large community hospital. Arch Surg. 2003;138:777\u201384.","journal-title":"Arch Surg"},{"key":"3464_CR7","doi-asserted-by":"publisher","DOI":"10.1016\/j.gassur.2025.101996","volume":"29","author":"K Kobayashi","year":"2025","unstructured":"Kobayashi K, Inoue Y, Takahashi Y. Efficacy of robot-assisted pancreaticoduodenectomy with left posterior approach for pancreatic head cancer with venous invasion. J Gastrointest Surg. 2025;29:101996.","journal-title":"J Gastrointest Surg"},{"key":"3464_CR8","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.12120","author":"S Kiritani","year":"2025","unstructured":"Kiritani S, Inoue Y, Sato T, et al. A left-posterior approach to the superior mesenteric artery during robot-assisted pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci. 2025. https:\/\/doi.org\/10.1002\/jhbp.12120.","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"3464_CR9","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1097\/XCS.0000000000000281","volume":"235","author":"Y Inoue","year":"2022","unstructured":"Inoue Y, Sato T, Kato T, et al. How can we optimize surgical view during robotic-assisted pancreaticoduodenectomy? Feasibility of multiple scope transition method. J Am Coll Surg. 2022;235:e1\u20137.","journal-title":"J Am Coll Surg"},{"key":"3464_CR10","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1002\/jhbp.905","volume":"29","author":"Y Nagakawa","year":"2022","unstructured":"Nagakawa Y, Watanabe Y, Kozono S, et al. Surgical approaches to the superior mesenteric artery during minimally invasive pancreaticoduodenectomy: a systematic review. J Hepatobiliary Pancreat Sci. 2022;29:114\u201323.","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"3464_CR11","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1002\/jhbp.12101","volume":"32","author":"S Nakamura","year":"2025","unstructured":"Nakamura S, Nakata K, Nagakawa Y, et al. The safety and feasibility of robotic pancreaticoduodenectomy: a multicenter retrospective assessment of 425 patients in Japan. J Hepatobiliary Pancreat Sci. 2025;32:124\u201331.","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"3464_CR12","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znae043","author":"N de Graaf","year":"2024","unstructured":"de Graaf N, Zwart MJW, van Hilst J, et al. Early experience with robotic pancreatoduodenectomy versus open pancreatoduodenectomy: nationwide propensity-score-matched analysis. Br J Surg. 2024. https:\/\/doi.org\/10.1093\/bjs\/znae043.","journal-title":"Br J Surg"},{"key":"3464_CR13","doi-asserted-by":"publisher","first-page":"e864","DOI":"10.1097\/SLA.0000000000005160","volume":"277","author":"Q Liu","year":"2023","unstructured":"Liu Q, Zhao Z, Zhang X, et al. Perioperative and oncological outcomes of robotic versus open pancreaticoduodenectomy in low-risk surgical candidates: A multicenter propensity score-matched study: A multicenter propensity score-matched study. Ann Surg. 2023;277:e864\u201371.","journal-title":"Ann Surg"},{"key":"3464_CR14","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1097\/SLA.0000000000005981","volume":"279","author":"F Nickel","year":"2024","unstructured":"Nickel F, Wise PA, M\u00fcller PC, et al. Short-term outcomes of robotic versus open pancreatoduodenectomy: propensity score-matched analysis: propensity score-matched analysis. Ann Surg. 2024;279:665\u201370.","journal-title":"Ann Surg"},{"key":"3464_CR15","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1016\/S2468-1253(24)00005-0","volume":"9","author":"Q Liu","year":"2024","unstructured":"Liu Q, Li M, Gao Y, et al. Effect of robotic versus open pancreaticoduodenectomy on postoperative length of hospital stay and complications for pancreatic head or periampullary tumours: a multicentre, open-label randomised controlled trial. Lancet Gastroenterol Hepatol. 2024;9:428\u201337.","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"3464_CR16","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2024.100864","volume":"39","author":"R Klotz","year":"2024","unstructured":"Klotz R, Mihaljevic AL, Kulu Y, et al. Robotic versus open partial pancreatoduodenectomy (EUROPA): a randomised controlled stage 2b trial. Lancet Reg Health Eur. 2024;39:100864.","journal-title":"Lancet Reg Health Eur"},{"key":"3464_CR17","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1002\/jhbp.1307","volume":"30","author":"Y Mise","year":"2023","unstructured":"Mise Y, Hirakawa S, Tachimori H, et al. Volume- and quality-controlled certification system promotes centralization of complex hepato-pancreatic-biliary surgery. J Hepatobiliary Pancreat Sci. 2023;30:851\u201362.","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"3464_CR18","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/S0140-6736(03)15268-3","volume":"363","author":"Appropriate body-mass","year":"2004","unstructured":"Appropriate body-mass. Index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157\u201363.","journal-title":"Lancet"},{"key":"3464_CR19","doi-asserted-by":"publisher","first-page":"e746","DOI":"10.1002\/osp4.746","volume":"10","author":"Y Yamamoto","year":"2024","unstructured":"Yamamoto Y, Ikeue K, Kanasaki M, et al. Age-wise examination of the association of obesity based on body mass index and waist circumference with metabolic diseases in comprehensive health checkup participants. Obes Sci Pract. 2024;10:e746.","journal-title":"Obes Sci Pract"},{"key":"3464_CR20","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","volume":"240","author":"D Dindo","year":"2004","unstructured":"Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205\u201313.","journal-title":"Ann Surg"},{"key":"3464_CR21","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1016\/j.surg.2016.11.014","volume":"161","author":"C Bassi","year":"2017","unstructured":"Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the international study group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017;161:584\u201391.","journal-title":"Surgery"},{"key":"3464_CR22","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1016\/j.surg.2007.05.005","volume":"142","author":"MN Wente","year":"2007","unstructured":"Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the international study group of pancreatic surgery (ISGPS). Surgery. 2007;142:761\u20138.","journal-title":"Surgery"},{"key":"3464_CR23","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/j.surg.2007.02.001","volume":"142","author":"MN Wente","year":"2007","unstructured":"Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an international study group of pancreatic surgery (ISGPS) definition. Surgery. 2007;142:20\u20135.","journal-title":"Surgery"},{"key":"3464_CR24","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1002\/jhbp.649","volume":"26","author":"H Kosaka","year":"2019","unstructured":"Kosaka H, Satoi S, Yamamoto T, et al. Clinical impact of the sequentially-checked drain removal criteria on postoperative outcomes after pancreatectomy: a retrospective study. J Hepatobiliary Pancreat Sci. 2019;26:426\u201334.","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"3464_CR25","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1016\/j.hpb.2019.11.005","volume":"22","author":"AL Moekotte","year":"2020","unstructured":"Moekotte AL, Rawashdeh A, Asbun HJ, et al. Safe implementation of minimally invasive pancreas resection: a systematic review. HPB (Oxford). 2020;22:637\u201348.","journal-title":"HPB (Oxford)"},{"key":"3464_CR26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/SLA.0b013e318296c732","volume":"258","author":"K Slankamenac","year":"2013","unstructured":"Slankamenac K, Graf R, Barkun J, et al. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg. 2013;258:1\u20137.","journal-title":"Ann Surg"},{"key":"3464_CR27","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1186\/s13063-023-07657-7","volume":"24","author":"N de Graaf","year":"2023","unstructured":"de Graaf N, Emmen AMLH, Ramera M, et al. Minimally invasive versus open pancreatoduodenectomy for pancreatic and peri-ampullary neoplasm (DIPLOMA-2): study protocol for an international multicenter patient-blinded randomized controlled trial. Trials. 2023;24:665.","journal-title":"Trials"},{"key":"3464_CR28","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1097\/SLA.0000000000002620","volume":"269","author":"TH Mungroop","year":"2019","unstructured":"Mungroop TH, van Rijssen LB, van Klaveren D, et al. Alternative fistula risk score for pancreatoduodenectomy (a-FRS): design and international external validation. Ann Surg. 2019;269:937\u201343.","journal-title":"Ann Surg"},{"key":"3464_CR29","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1097\/SLA.0000000000003234","volume":"273","author":"TH Mungroop","year":"2021","unstructured":"Mungroop TH, Klompmaker S, Wellner UF, et al. Updated alternative fistula risk score (ua-FRS) to include minimally invasive pancreatoduodenectomy: Pan-European validation. Ann Surg. 2021;273:334\u201340.","journal-title":"Ann Surg"},{"key":"3464_CR30","doi-asserted-by":"publisher","first-page":"1858","DOI":"10.1007\/s00268-012-1567-3","volume":"36","author":"F Frozanpor","year":"2012","unstructured":"Frozanpor F, Loizou L, Ansorge C, et al. Preoperative pancreas CT\/MRI characteristics predict fistula rate after pancreaticoduodenectomy. World J Surg. 2012;36:1858\u201365.","journal-title":"World J Surg"},{"key":"3464_CR31","doi-asserted-by":"publisher","first-page":"e198","DOI":"10.1097\/AS9.0000000000000198","volume":"3","author":"CM Halloran","year":"2022","unstructured":"Halloran CM, Neoptolemos JP, Jackson R, et al. A multicenter, randomized, double-blinded, clinical trial comparing Cattell-Warren and Blumgart anastomoses following partial pancreatoduodenectomy: PANasta trial: PANasta trial. Ann Surg Open. 2022;3:e198.","journal-title":"Ann Surg Open"},{"key":"3464_CR32","doi-asserted-by":"publisher","first-page":"1438","DOI":"10.1016\/j.surg.2023.02.020","volume":"173","author":"N Napoli","year":"2023","unstructured":"Napoli N, Cacace C, Kauffmann EF, et al. The PD-ROBOSCORE: a difficulty score for robotic pancreatoduodenectomy. Surgery. 2023;173:1438\u201346.","journal-title":"Surgery"}],"container-title":["BMC Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12893-025-03464-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-025-03464-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-025-03464-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T14:39:56Z","timestamp":1770388796000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12893-025-03464-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,9]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3464"],"URL":"https:\/\/doi.org\/10.1186\/s12893-025-03464-w","relation":{},"ISSN":["1471-2482"],"issn-type":[{"value":"1471-2482","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,9]]},"assertion":[{"value":"22 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 January 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":"The study protocol has been approved by the Certified Review Board of the Cancer Institute Hospital.","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":"113"}}