{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T09:37:35Z","timestamp":1793353055222,"version":"4.5.0"},"reference-count":55,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"publisher","award":["RF-2021-12373900"],"award-info":[{"award-number":["RF-2021-12373900"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Thoracic surgery has progressively moved from open thoracotomy to video-assisted and robot-assisted approaches, reducing access-related trauma while changing the technical environment in which pulmonary resections are performed and taught. This narrative review examines the clinical evolution of open, video-assisted thoracic surgery (VATS), and robot-assisted thoracic surgery (RATS), with particular attention to the evidence supporting their perioperative and oncological outcomes, the learning curves associated with minimally invasive surgery, and the role of simulation-based training. Randomized trials now provide robust evidence that VATS improve postoperative recovery compared with thoracotomy in appropriately selected patients with predominantly early-stage non-small cell lung cancer, without compromising long-term oncological outcomes. Randomized comparisons between RATS and VATS support RATS as an oncologically acceptable minimally invasive alternative and suggest advantages in selected technical endpoints, particularly blood loss and lymph node retrieval, but do not demonstrate consistent superiority in major clinical or survival outcomes. Learning curves vary according to previous experience, case complexity, supervision, institutional volume, and the endpoint used to define competence, making fixed case-number thresholds an incomplete measure of proficiency. Simulation can improve selected technical skills and provide objective performance assessment, although evidence becomes progressively less robust when moving from simulator performance to operating room transfer and patient-level outcomes. Surgical approach, therefore, should be interpreted within a broader framework that includes patient and tumour characteristics, oncological quality, surgical expertise, institutional resources, and structured training.<\/jats:p>","DOI":"10.3390\/cancers18193193","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T16:50:38Z","timestamp":1790959838000},"page":"3193","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["From Thoracotomy to Robotic Platforms in Thoracic Surgery: Technical Evolution, Simulation-Based Training, and Surgical Outcomes"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3609-1587","authenticated-orcid":false,"given":"Michele","family":"Piazzolla","sequence":"first","affiliation":[{"name":"Unit of Thoracic Surgery, Fondazione IRCCS Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doroty","family":"Sampietro","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Fondazione IRCCS Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco Donatello","family":"Delcuratolo","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Fondazione IRCCS Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0554-5865","authenticated-orcid":false,"given":"Paolo Nicola Camillo","family":"Girotti","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Fondazione IRCCS Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1866-8151","authenticated-orcid":false,"given":"Lucia Anna","family":"Muscarella","sequence":"additional","affiliation":[{"name":"Lung Cancer Research Unit, Fondazione IRCCS Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0591-6723","authenticated-orcid":false,"given":"Paola","family":"Parente","sequence":"additional","affiliation":[{"name":"Unit of Pathology, Azienda Ospedaliera Universitaria Ospedali Riuniti, 71100 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.ejcts.2006.08.008","article-title":"ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer","volume":"30","author":"Lardinois","year":"2006","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"ezad224","DOI":"10.1093\/ejcts\/ezad224","article-title":"European Society of Thoracic Surgeons expert consensus recommendations on technical standards of segmentectomy for primary lung cancer","volume":"63","author":"Brunelli","year":"2023","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2779","DOI":"10.1016\/j.jtcvs.2017.12.149","article-title":"Milestones in thoracic surgery","volume":"155","author":"Khaitan","year":"2018","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4993","DOI":"10.1200\/JCO.2007.12.6649","article-title":"Video-assisted thoracic surgery lobectomy: Report of CALGB 39802--a prospective, multi-institution feasibility study","volume":"25","author":"Swanson","year":"2007","journal-title":"J. Clin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1016\/S1470-2045(16)00173-X","article-title":"Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: A randomised controlled trial","volume":"17","author":"Bendixen","year":"2016","journal-title":"Lancet Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/j.athoracsur.2017.08.045","article-title":"Thoracoscopic surgery versus thoracotomy for lung cancer: Short-term outcomes of a randomized trial","volume":"105","author":"Long","year":"2018","journal-title":"Ann. Thorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"EVIDoa2100016","DOI":"10.1056\/EVIDoa2100016","article-title":"Video-assisted thoracoscopic or open lobectomy in early-stage lung cancer","volume":"1","author":"Lim","year":"2022","journal-title":"NEJM Evid."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1016\/S0140-6736(26)00031-0","article-title":"Survival outcome of VATS compared with open lobectomy for lung cancer: An individual patient data meta-analysis of randomised trials","volume":"407","author":"Harris","year":"2026","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"24","DOI":"10.5761\/atcs.ra.24-00137","article-title":"Outcomes of uniportal video-assisted thoracoscopic surgery in the management of lobectomy and segmentectomy for lung cancer: A systematic review and meta-analysis of propensity score-matched cohorts","volume":"31","author":"Sudarma","year":"2025","journal-title":"Ann. Thorac. Cardiovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"446","DOI":"10.21037\/tlcr-22-635","article-title":"Perioperative and oncological outcomes of uniportal versus three-port thoracoscopic segmentectomy for lung cancer: A propensity score matching analysis","volume":"12","author":"Zhou","year":"2023","journal-title":"Transl. Lung Cancer Res."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Veronesi, G., Abbas, A.E.-S., Muriana, P., Lembo, R., Bottoni, E., Perroni, G., Testori, A., Dieci, E., Bakhos, C.T., and Car, S. (2021). Perioperative outcome of robotic approach versus manual videothoracoscopic major resection in patients affected by early lung cancer: Results of a randomized multicentric study (ROMAN Study). Front Oncol., 11.","DOI":"10.3389\/fonc.2021.726408"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1097\/SLA.0000000000004922","article-title":"Robotic-assisted versus video-assisted thoracoscopic lobectomy: Short-term results of a randomized clinical trial (RVlob Trial)","volume":"275","author":"Jin","year":"2022","journal-title":"Ann. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1097\/SLA.0000000000006073","article-title":"Robotic lobectomy is cost-effective and provides comparable health utility scores to video-assisted lobectomy: Early results of the RAVAL Trial","volume":"278","author":"Patel","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"102707","DOI":"10.1016\/j.eclinm.2024.102707","article-title":"Robotic-assisted versus video-assisted lobectomy for resectable non-small-cell lung cancer: The RVlob randomized controlled trial","volume":"74","author":"Niu","year":"2024","journal-title":"eClinicalMedicine"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"777","DOI":"10.21037\/jtd-2026-0917","article-title":"Robotic vs. video-assisted thoracoscopic surgery for resectable non-small cell lung cancer: A systematic review and meta-analysis of randomized controlled trials","volume":"18","author":"Ren","year":"2026","journal-title":"J. Thorac. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S427","DOI":"10.21037\/jtd.2016.03.82","article-title":"VATS lobectomy program: The trainee perspective","volume":"8","author":"Sandri","year":"2016","journal-title":"J. Thorac. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2058","DOI":"10.21037\/jtd.2019.02.39","article-title":"Structured and evidence-based training of technical skills in respiratory medicine and thoracic surgery","volume":"13","author":"Pietersen","year":"2021","journal-title":"J. Thorac. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.thorsurg.2022.07.009","article-title":"Resident training in robotic thoracic surgery","volume":"33","author":"Mitzman","year":"2023","journal-title":"Thorac. Surg. Clin."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"4173","DOI":"10.1007\/s00464-018-6162-8","article-title":"A novel assessment tool for evaluating competence in video-assisted thoracoscopic surgery lobectomy","volume":"32","author":"Jensen","year":"2018","journal-title":"Surg. Endosc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"ivac194","DOI":"10.1093\/icvts\/ivac194","article-title":"The use of objective assessments in the evaluation of technical skills in cardiothoracic surgery: A systematic review","volume":"35","author":"Hussein","year":"2022","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_21","first-page":"47","article-title":"Learning curve associated with VATS lobectomy","volume":"1","author":"Petersen","year":"2012","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1016\/j.jtcvs.2013.11.036","article-title":"Competence versus mastery: The time course for developing proficiency in video-assisted thoracoscopic lobectomy","volume":"147","author":"Li","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.athoracsur.2018.07.074","article-title":"Defining proficiency for The Society of Thoracic Surgeons participants performing thoracoscopic lobectomy","volume":"107","author":"Puri","year":"2019","journal-title":"Ann. Thorac. Surg."},{"key":"ref_24","first-page":"ivad135","article-title":"Uniportal video-assisted thoracoscopic surgery for lobectomy: The learning curve","volume":"37","author":"Laven","year":"2023","journal-title":"Interdiscip. Cardiovasc. Thorac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"12","DOI":"10.21037\/atm-21-6113","article-title":"Learning curve for uniportal video-assisted thoracoscopic anatomical segmentectomy","volume":"10","author":"Chen","year":"2022","journal-title":"Ann. Transl. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.xjon.2025.07.011","article-title":"Exploring and analyzing learning curves in robotic-assisted thoracoscopic anatomical lung resections: A systematic review and meta-analysis","volume":"27","author":"Qu","year":"2025","journal-title":"JTCVS Open"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"ezad058","DOI":"10.1093\/ejcts\/ezad058","article-title":"Consensus on technical procedures for simulation-based training in thoracic surgery: An international needs assessment","volume":"63","author":"Haidari","year":"2023","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1055\/s-2007-965739","article-title":"New trainer for video-assisted thoracic surgery lobectomy","volume":"56","author":"Iwasaki","year":"2008","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"65","DOI":"10.21037\/jovs.2017.02.07","article-title":"Video-assisted thoracoscopic surgery training with a polyvinyl-alcohol hydrogel model mimicking real tissue","volume":"3","author":"Sato","year":"2017","journal-title":"J. Vis. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"52","DOI":"10.21037\/shc.2018.06.04","article-title":"Training of video-assisted thoracoscopic surgery lobectomy: The role of simulators","volume":"2","author":"Stupnik","year":"2018","journal-title":"Shanghai Chest"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1093\/ejcts\/ezy276","article-title":"Simulation training for lobectomy: A review of current literature and future directions","volume":"55","author":"Nashaat","year":"2019","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2520","DOI":"10.1007\/s00464-016-5254-6","article-title":"Using virtual reality simulation to assess competence in video-assisted thoracoscopic surgery (VATS) lobectomy","volume":"31","author":"Jensen","year":"2017","journal-title":"Surg. Endosc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"S8","DOI":"10.21037\/jtd-20-1628","article-title":"Robotic lobectomy: How to teach thoracic residents","volume":"13","author":"Terra","year":"2021","journal-title":"J. Thorac. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/j.urology.2012.10.020","article-title":"Da Vinci Skills Simulator for assessing learning curve and criterion-based training of robotic basic skills","volume":"81","author":"Brinkman","year":"2013","journal-title":"Urology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1007\/s11701-021-01363-9","article-title":"Developing basic robotic skills using virtual reality simulation and automated assessment tools: A multidisciplinary robotic virtual reality-based curriculum using the Da Vinci Skills Simulator and tracking progress with the Intuitive Learning platform","volume":"16","author":"Gleason","year":"2022","journal-title":"J. Robot. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s11701-024-02187-z","article-title":"Virtual reality simulations in robotic surgery training: A systematic review and meta-analysis","volume":"19","author":"Kawashima","year":"2024","journal-title":"J. Robot. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"4779","DOI":"10.1038\/s41598-024-55351-8","article-title":"Design and preliminary validation of a high-fidelity vascular simulator for robot-assisted manipulation","volume":"14","author":"Gamberini","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/j.athoracsur.2024.12.003","article-title":"The Society of Thoracic Surgeons expert consensus statements on a framework for a standardized national robotic curriculum for thoracic surgery trainees","volume":"119","author":"Kim","year":"2025","journal-title":"Ann. Thorac. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1016\/j.athoracsur.2023.05.002","article-title":"Current status of simulation in thoracic surgical training","volume":"116","author":"Whittaker","year":"2023","journal-title":"Ann. Thorac. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"6674","DOI":"10.21037\/jtd-23-1288","article-title":"Objective improvement in dexterity for trainees undergoing a video-assisted thoracoscopic surgery simulation program, a prospective single center study","volume":"15","author":"Koliakos","year":"2023","journal-title":"J. Thorac. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1002\/bjs.9482","article-title":"Systematic review of skills transfer after surgical simulation-based training","volume":"101","author":"Dawe","year":"2014","journal-title":"Br. J. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"zraa066","DOI":"10.1093\/bjsopen\/zraa066","article-title":"Virtual reality simulation in robot-assisted surgery: Meta-analysis of skill transfer and predictability of skill","volume":"5","author":"Schmidt","year":"2021","journal-title":"BJS Open"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"103833","DOI":"10.1016\/j.jsurg.2025.103833","article-title":"Evidence of skill transferability from training in virtual reality robotic surgery simulators to nonvirtual environments: A systematic review","volume":"83","author":"Sarmento","year":"2026","journal-title":"J. Surg. Educ."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1007\/s11701-026-03275-y","article-title":"Simulation in robotic-assisted thoracic surgery: A systematic review","volume":"20","author":"Walji","year":"2026","journal-title":"J. Robot. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1007\/s11701-026-03660-7","article-title":"Transfer of technical skills from virtual reality robotic simulation to non-virtual surgical performance: A systematic review and meta-analysis","volume":"20","author":"Alsamhori","year":"2026","journal-title":"J. Robot. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.surg.2020.09.010","article-title":"Pulmonary lobectomy for cancer: Systematic review and network meta-analysis comparing open, video-assisted thoracic surgery, and robotic approach","volume":"169","author":"Aiolfi","year":"2021","journal-title":"Surgery"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/THBQ1793","article-title":"Impact of video-assisted thoracoscopic lobectomy versus open lobectomy for lung cancer on recovery assessed using self-reported physical function: VIOLET RCT","volume":"26","author":"Lim","year":"2022","journal-title":"Health Technol. Assess."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1007\/s11701-026-03326-4","article-title":"Multicenter study comparing outcomes of robotic versus video-assisted thoracoscopic resection of non-small cell lung cancer following neoadjuvant chemoimmunotherapy","volume":"20","author":"Srivatsa","year":"2026","journal-title":"J. Robot. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1186\/s12957-016-1038-7","article-title":"Thoracotomy is better than thoracoscopic lobectomy in the lymph node dissection of lung cancer: A systematic review and meta-analysis","volume":"14","author":"Zhang","year":"2016","journal-title":"World J. Surg. Oncol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"10629","DOI":"10.1097\/JS9.0000000000004800","article-title":"Evaluation of lymph nodes in various surgical approaches for clinical N0 lung cancer: A systematic review and network meta-analysis","volume":"112","author":"Zheng","year":"2026","journal-title":"Int. J. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1177\/1556984519837027","article-title":"Optimal Approach to Lobectomy for Non-Small Cell Lung Cancer: Systemic Review and Meta-Analysis","volume":"14","author":"Ng","year":"2019","journal-title":"Innovations"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Bertolaccini, L., Prisciandaro, E., Bardoni, C., Cara, A., Diotti, C., Girelli, L., and Spaggiari, L. (2022). Minimally invasive anatomical segmentectomy versus lobectomy in stage IA non-small cell lung cancer: A systematic review and meta-analysis. Cancers, 14.","DOI":"10.3390\/cancers14246157"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1097\/SLA.0000000000001708","article-title":"Long-term survival based on the surgical approach to lobectomy for clinical stage I nonsmall cell lung cancer: Comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy","volume":"265","author":"Yang","year":"2017","journal-title":"Ann. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"9104","DOI":"10.3390\/curroncol30100658","article-title":"Robotic versus open surgery in locally advanced non-small cell lung cancer: Evaluation of surgical and oncological outcomes","volume":"30","author":"Zirafa","year":"2023","journal-title":"Curr. Oncol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1097\/SLA.0000000000005698","article-title":"The RECOURSE study: Long-term oncologic outcomes associated with robotically assisted minimally invasive procedures for endometrial, cervical, colorectal, lung, or prostate cancer: A systematic review and meta-analysis","volume":"277","author":"Leitao","year":"2023","journal-title":"Ann. Surg."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/19\/3193\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:13:31Z","timestamp":1791951211000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/19\/3193"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,2]]},"references-count":55,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["cancers18193193"],"URL":"https:\/\/doi.org\/10.3390\/cancers18193193","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,2]]}}}