Training the next generation of minimally invasive HPB surgeons: are current fellowships crossing the learning curve?

Abstract Background Minimally invasive surgery (MIS) improved outcomes in hepatopancreatobiliary (HPB) cases, yet adoption is slowed by technical complexity and steep learning curves. This retrospective review sought to characterize MIS training variations across three fellowship pathways: HPB, complex general surgical oncology (CGSO), and transplant (TXP). Methods We analyzed anonymized Fellowship Council case logs (2014–2023) for 146 HPB, 55 CGSO, and 51 TXP fellows seeking AHPBA certification. Procedures were categorized by platform and type. Results HPB fellows logged significantly more total robotic cases (HPB: 12.5, CGSO: 8.5, TXP: 1.0, p < 0.01), including robotic pancreaticoduodenectomies (HPB 4.4, CGSO 3.0, TXP 0.2, p < 0.01) and robotic distal pancreatectomies (HPB 3.8, CGSO 3.2, TXP 0.6, p < 0.01). Although TXP fellows performed more open major liver resections (HPB 24.0, CGSO 24.7, TXP 35.2, p < 0.01), robotic anatomic (HPB 2.1, CGSO 1.5, TXP 0.03, p 0.01) and non-anatomic liver resections (HPB 1.8, CGSO 1.4, TXP 0.2, p < 0.01) were highest among HPB fellows. Discussion Meaningful differences in MIS operative exposure exist across training pathways, with TXP fellows trailing significantly in robotic experience. These findings highlight a critical need for standardized MIS curricula to ensure technical proficiency across all HPB surgery pipelines.