Pan-European Training Program for Robotic Pancreatoduodenectomy (LEARNBOT)

Objective: To assess the feasibility of and clinical outcomes after a pan-European training program for robotic pancreatoduodenectomy (RPD). Summary Background Data: 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. Study Design: A structured training program for RPD was implemented, and outcomes 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’ 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, and major correlated with conversion and postoperative outcomes. Results: Overall, 486 RPD procedures were performed. Median intraoperative blood loss was 200 mL (IQR: 100–400), operative time was 475 minutes (IQR: 414–553.3), and the conversion rate was 18.3% (n=89). The rate of Clavien-Dindo grade ≥III 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: 8–20). During simulation training, OSATS scores significantly improved (0.350 points/attempt ( ρ ), P <0.001) while the duration of reconstruction decreased ( P <0.001). Multivariable analysis found no association between error count and major complications. Conclusions: We report on the first successfully completed international training program for RPD. Simulation established a standardized technical competency, although a learning-curve effect (major complications) remained detectable per center. These data highlight that safe adoption of complex procedures requires structured, team-based, proctored training beyond simulation alone.

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Publication Details

Journal
Annals of Surgery
Published
2026-10-07
DOI
https://doi.org/10.1097/sla.0000000000007170
Primary Topic
Surgical Simulation and Training
Type
article
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article

Pan-European Training Program for Robotic Pancreatoduodenectomy (LEARNBOT)

Thilo Hackert, Zahir Soonawalla, Leia R. Jones, Maurice J. W. Zwart et al.
Annals of Surgery
Surgical Simulation and Training
article

Pan-European Training Program for Robotic Pancreatoduodenectomy (LEARNBOT)

Thilo Hackert, Zahir Soonawalla, Leia R. Jones, Maurice J. W. Zwart, Paul Suno Krohn, Giovanni Marchegiani, Ernesto Sparrelid, Martin Loveček, Bergþór Björnsson, Ferrari Giovanni, Emre Bozkurt, Emanuel Vigia, Rawin Amiri, S. White, Declan Dunne, Quintus Molenaar, Maxime Dewulf, Marc G. Besselink, Felix Nickel, B Groot Koerkamp, Melissa E. Hogg, Tim Worthington, Christian Toso, Olivier Saint Marc, Sebastiaan Festen, Olivier Busch, Edoardo Rosso, Peter Strandberg-Holka, Benjamin Strücker, Philip Leenart, Filip Gryspeerdt, Ugo Boggi, Maximilian Schmeding, Freek Daams, Mahsoem Ali, Mohammad Abu Hilal, Martijn Stommel
article en

Abstract

Objective: To assess the feasibility of and clinical outcomes after a pan-European training program for robotic pancreatoduodenectomy (RPD). Summary Background Data: 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. Study Design: A structured training program for RPD was implemented, and outcomes 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’ 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, and major correlated with conversion and postoperative outcomes. Results: Overall, 486 RPD procedures were performed. Median intraoperative blood loss was 200 mL (IQR: 100–400), operative time was 475 minutes (IQR: 414–553.3), and the conversion rate was 18.3% (n=89). The rate of Clavien-Dindo grade ≥III 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: 8–20). During simulation training, OSATS scores significantly improved (0.350 points/attempt ( ρ ), P <0.001) while the duration of reconstruction decreased ( P <0.001). Multivariable analysis found no association between error count and major complications. Conclusions: We report on the first successfully completed international training program for RPD. Simulation established a standardized technical competency, although a learning-curve effect (major complications) remained detectable per center. These data highlight that safe adoption of complex procedures requires structured, team-based, proctored training beyond simulation alone.

Annals of Surgery
University of Pisa (IT), University of Jordan (JO), Karolinska University Hospital (SE), NorthShore University HealthSystem (US), Koç University (TR), University of Padua (IT), University of Liverpool (GB), Centre Hospitalier de Luxembourg (LU), Maastricht University Medical Centre (NL), Ghent University Hospital (BE), Newcastle upon Tyne Hospitals NHS Foundation Trust (GB), Erasmus MC (NL), Rigshospitalet (DK), Royal Liverpool University Hospital (GB), Amsterdam UMC Location University of Amsterdam (NL), Radboud University Medical Center (NL), University Hospital Southampton NHS Foundation Trust (GB), University Medical Center Utrecht (NL), Maastricht University (NL), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), University Hospital Münster (DE), OLVG (NL), University Hospital of Geneva (CH), University Hospital Olomouc (CZ), University Medical Center Hamburg-Eppendorf (DE), Klinikum Dortmund (DE), Hospital Curry Cabral (PT), Skåne University Hospital (SE), Royal Surrey NHS Foundation Trust (GB), Oxford University Hospitals NHS Trust (GB), Fondazione Poliambulanza Istituto Ospedaliero (IT), Amsterdam University Medical Centers (NL), Linköping University Hospital (SE), Cancer Center Amsterdam (NL), Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
Openalex Percentile: Top 9%
Surgical Simulation and Training
DOIOpen Access PDFOpenAlex
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