Pan-European Training Program for Robotic Pancreatoduodenectomy (LEARNBOT)

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.