Journal of Robotic Surgery最新文献

{"title":"Medical liability in paediatric robotic surgery - a current concept and a literature review.","authors":"Ciro Esposito, Anna Gargiulo, Claudia Di Mento, Marco Castagnetti, Vincenzo Coppola, Francesco Tedesco, Roberta Guglielmini, Maria Luisa Pirone, Chiara Caporale, Maria Escolino","doi":"10.1007/s11701-026-04033-w","DOIUrl":"10.1007/s11701-026-04033-w","url":null,"abstract":"<p><p>Robotic-assisted surgery offers significant technical advantages in pediatric procedures but presents complex, unresolved medico-legal challenges regarding liability. We retrospectively reviewed our ten-year experience comprising 205 pediatric robotic procedures. Technical issues related to the robot were encountered in 7 cases (3.4%). These included joystick latency (3/7), coagulation/cutting pedal malfunctions (2/7), and accidental power cable disconnections causing system shutdowns (2/7). A literature review was conducted to assess the current international state of the art regarding robotic medical liability. Although the technical events at our center did not result in clinical complications, they highlighted significant potential risks. The literature shows that specific guidelines governing human, product, and algorithm-related liability are still lacking. Robotic surgery shifts the focus from an exclusively fault-based liability of the surgeon to a network-based system involving multiple stakeholders: the surgeon, the healthcare institution, and the manufacturer. Determining whether an adverse event stems from human error, algorithmic malfunction, or a combination of both remains a critical challenge. Unlike open or laparoscopic surgery where liability is primarily attributed to the operator, robotic surgery involves a complex interaction between the surgeon's console inputs and the manufacturer's technology. Consequently, from a medico-legal standpoint, responsibility for complications should be shared among the surgeon, the hospital, and the device manufacturer.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncological outcomes after Senhance robot-assisted radical prostatectomy: biochemical recurrence and risk stratification in a large single-centre cohort.","authors":"Toni Zekulic, Tomislav Kulis, Tvrtko Hudolin, Luka Penezic, Jerko Andelic, Tomislav Sambolic, Domagoj Saric, Nikola Knezevic, Zeljko Kastelan","doi":"10.1007/s11701-026-04031-y","DOIUrl":"10.1007/s11701-026-04031-y","url":null,"abstract":"<p><p>To evaluate biochemical recurrence (BCR) after Senhance robot-assisted radical prostatectomy and identify its predictors. We retrospectively analysed consecutive patients undergoing Senhance radical prostatectomy between November 2019 and March 2025. BCR was defined as a postoperative PSA of 0.2 ng/mL or above, confirmed on a subsequent measurement. Patients whose first postoperative PSA reached this threshold were classified as persistent PSA and excluded. BCR-free survival was estimated and an exploratory score assigned one point each for pT3 stage, grade group 3 or above, positive margin and intraductal carcinoma. Of 824 patients, 813 had evaluable follow-up; 22 (2.7%) had persistent PSA, leaving 791. Median preoperative PSA was 7.3 ng/mL; 276 (34.9%) had pT3 disease and 270 (34.1%) a positive margin. Median follow-up was 26 months and BCR occurred in 88 patients (11.1%). BCR-free survival was 93.5%, 89.6% and 86.9% at 12, 24 and 36 months. Independent predictors were preoperative PSA (HR 1.70), grade group (HR 1.83), pT3b stage (HR 2.22), positive margin (HR 2.04), lymphovascular invasion (HR 2.00) and intraductal carcinoma (HR 2.00). Twenty-four-month BCR-free survival ranged from 99.7% with no adverse factors to 55.8% with three or more. Short- to intermediate-term biochemical control was within the range reported in contemporary RARP series, although cross-platform comparison is not possible without a comparator. Recurrence was associated with established adverse pathology, and an exploratory four-factor score separated patients into markedly different risk groups, pending external validation.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning curves of surgeon performance and team workflow during the first 100 hugo robotic-assisted small bowel length shortening with sleeve gastrectomy procedures.","authors":"Chih-Kun Huang, Larry Weng-Hong Lai, Ming-Che Hsin, Szu-Chia Huang, Po-Chih Chang, Long-Bin Jeng, Ting-Wei Chang","doi":"10.1007/s11701-026-04011-2","DOIUrl":"10.1007/s11701-026-04011-2","url":null,"abstract":"<p><p>Evidence on Hugo RAS in bariatric surgery remains limited. We evaluated the first 100 Hugo RAS small bowel length shortening with sleeve gastrectomy (BOS-SG) procedures to determine whether surgeon-level technical performance (console time) and team-level workflow (docking time) evolved differently during implementation. This retrospective single-center cohort included consecutive cases performed between February 11 and July 30, 2025. Change points were assessed using segmented linear regression, Davies tests, 95% confidence intervals, and descriptive cumulative sum (CUSUM) analysis. Early and late phases were defined by the rounded docking-time breakpoint, the most stable interpretable workflow transition. Among 100 cases, median console time was 16.0 min (interquartile range [IQR], 15.0-21.2) and docking time was 5.0 min (IQR, 3.0-5.2). CUSUM peaks occurred at cases 24 and 28, respectively. Segmented regression identified a docking-time breakpoint at case 33.1 (95% CI, 26.2-40.0; Davies p < 0.001); the console-time segmented solution was early and was not retained. From early to late phase, console time decreased from 23.0 to 16.0 min (p < 0.001), docking time from 6.0 to 4.0 min descriptively, and total operative time from 95.0 to 77.0 min (p < 0.001). Complications occurred in 1/33 and 7/67 cases (p = 0.265). Hugo RAS BOS-SG implementation showed distinct, complementary learning trajectories. Docking time, a team-workflow metric, demonstrated the most stable transition around 30-40 cases, whereas console performance improved without a stable mid-series breakpoint. Console and docking time should be treated as noninterchangeable endpoints for platform adoption.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted versus non-robotic partial nephrectomy for completely endophytic renal tumors: a systematic review and meta-analysis.","authors":"Jian-Wei Yang, Li Wang, Hong-Man Chen, Si-Yu Chen, Li Yang","doi":"10.1007/s11701-026-04018-9","DOIUrl":"10.1007/s11701-026-04018-9","url":null,"abstract":"<p><p>Completely endophytic renal tumors (CERTs), which are entirely confined within the renal parenchyma, present substantial technical challenges during nephron-sparing surgery. We conducted a systematic review and meta-analysis to compare robot-assisted partial nephrectomy (RAPN) with laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) specifically for CERTs. PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library were searched through August 24, 2026. Eligible comparative studies directly evaluated RAPN versus LPN and/or OPN. Continuous outcomes were summarized using mean differences (MDs) and binary outcomes using risk ratios (RRs), with 95% confidence intervals (CIs). RAPN-LPN and RAPN-OPN comparisons were analyzed separately. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS), and the protocol was registered in PROSPERO (CRD420261488778). Seven studies involving 896 patients were included, of whom 430 underwent RAPN and 466 underwent LPN or OPN. No statistically significant difference in operative time was detected between RAPN and either LPN or OPN. Estimated blood loss also did not differ significantly between RAPN and LPN (MD - 14.92 mL, 95% CI - 48.82 to 18.98; P = 0.39) or OPN (MD - 85.62 mL, 95% CI - 176.01 to 4.78; P = 0.06). RAPN was associated with a shorter hospital stay than OPN (MD - 1.64 days, 95% CI - 2.29 to - 0.98; P < 0.00001), whereas no significant difference was observed versus LPN. The lower transfusion risk with RAPN versus OPN was of borderline significance (RR 0.39, 95% CI 0.16-0.99; P = 0.05). No statistically significant differences were detected in conversion to radical nephrectomy, major complications, positive surgical margins, or 1-year postoperative eGFR. Ischemia-related outcomes were reported descriptively because operative ischemia strategies differed across studies. Overall, RAPN showed selected perioperative differences mainly in comparison with OPN, whereas most outcomes did not differ significantly from LPN. These findings should be interpreted cautiously because the evidence was based on a small number of predominantly observational studies with substantial heterogeneity for several outcomes.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning curves in robotic and laparoscopic colorectal surgery: a systematic review.","authors":"Fabio Nocera, Felicitas Wiedemann, Philip C Müller, Adrian T Billeter, Fiorenzo V Angehrn, Beat P Müller, Daniel C Steinemann, Christoph Kuemmerli","doi":"10.1007/s11701-026-04024-x","DOIUrl":"https://doi.org/10.1007/s11701-026-04024-x","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate and compare learning-curve assessment in laparoscopic and robotic colorectal surgery and to develop a standardized framework for future learning-curve reporting.</p><p><strong>Background: </strong>Learning curves in minimally invasive colorectal surgery are widely reported, but inconsistent definitions limit interpretability and comparability. This systematic review analyzed learning-curve assessment in laparoscopic and robotic colorectal surgery and proposes a standardized framework.</p><p><strong>Methods: </strong>MEDLINE, Web of Science, and CENTRAL were systematically searched according to PRISMA guidelines (registered in PROSPERO, CRD42026128860). Included were randomized, prospective, and retrospective studies on learning curves in colorectal surgery. Primary outcome was the number of procedures required to reach the initial learning phase. Secondary outcomes included definitions of learning curves, analytical methods, and classification of learning phases. Analyses were stratified by procedure type (colon vs. rectal resections), and pooled breakpoint regression was used to identify learning phases.</p><p><strong>Results: </strong>A total of 114 studies comprising 167 learning-curve analyses were included. CUSUM or risk-adjusted CUSUM was used in 66.4% of analyses, whereas 33.3% applied arbitrary definitions; operative time was the most frequently used endpoint (79.6%). Operative-time plateaus were identified after 38 colonic and 56 rectal procedures. Reported median competency thresholds were numerically lower for robotic than laparoscopic surgery in colonic resections (24 vs. 30 cases; p = 0.659) and rectal resections (28 vs. 38 cases; p = 0.140), but these differences were not statistically significant.</p><p><strong>Conclusions: </strong>Learning-curve assessment in minimally invasive colorectal surgery remains heterogeneous. Robotic series report numerically lower competency thresholds than laparoscopic series; however, this likely reflects skill transfer from prior laparoscopic experience and modern training pathways rather than an intrinsically shorter learning curve of the robotic platform. Differences in prior surgeon experience, training, and study era limit direct comparison. Standardized assessment and prospective studies with comparable baseline exposure are needed.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity, reliability, and predictive performance of a multi-tool competency assessment framework in a multi-specialty robotic surgery training program: the WETPROF experience.","authors":"Nicolas Berte, Clémence Havret, Julie Lienard, Adrien Montazeaud, Samy Benbetka, Jean-Pierre Henry, Jacques Hubert, Charles Mazeaud, Nguyen Tran","doi":"10.1007/s11701-026-04022-z","DOIUrl":"10.1007/s11701-026-04022-z","url":null,"abstract":"<p><p>Structured robotic surgery curricula increasingly integrate simulation, dry lab, microsurgery and high-fidelity wet lab training, yet few studies have comprehensively evaluate how performances across these educational components relate to final proficiency in a multimodal curriculum. We aimed to evaluate the WETPROF inter-university robotic surgery diploma curriculum by analyzing relationships between theoretical knowledge, simulator performance, practical training modules and final wet lab performance, while assessing the reliability and convergent validity of the assessment instruments used throughout the program. We retrospectively analyzed prospectively collected data from 131 surgeons enrolled in the WETPROF curriculum between 2023 and 2025. Training included theoretical assessment, DvTrainer virtual reality simulation, microsurgery, GEARS-rated FRS Dome exercises and a final porcine wet lab evaluated using GEARS, ARCS and NOTSS. Internal consistency was assessed using Cronbach's alpha, convergent validity with Spearman correlations, group comparisons using non-parametric tests, and multivariable regression models were used to identify predictors of simulator progression and final wet lab performance. The wet lab assessment instruments demonstrated excellent internal consistency (Cronbach's α=0.975) and very strong convergent validity (ρ=0.85-0.89; all p<0.001). Baseline theoretical knowledge was not associated with either simulator or wet lab performance. Prior robotic experience significantly improved simulator progression, particularly DvTrainer performance (effect size r=0.525), whereas its influence on final wet lab performance was limited. DvTrainer curriculum score was independently predicted by GEARS FRS Dome, microsurgery performance and GEARS Wet Lab (R²=0.480). In contrast, wet lab performance was only weakly explained by demographic characteristics (R²=0.156), with DvTrainer score emerging as the only independent external predictor (β=+0.220, p=0.016). These findings indicate that simulator progression and wet lab performance represent complementary dimensions of surgical competence. The WETPROF curriculum provides a coherent multimodal framework for robotic surgery training. The excellent reliability and convergent validity of the assessment instruments support their use within competency-based education. Although theoretical knowledge and prior experience contribute little to final wet lab performance, progression through the simulation curriculum is associated with better technical performance in a high-fidelity environment, supporting the educational value of a progressive simulation-based pathway before clinical practice.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond total operative time: phase-specific robotic efficiency and postoperative morbidity following colorectal resection - a multisurgeon cohort study.","authors":"Mohamed Amin, Mohamed Abosheisha, Mohamed Salama, Michael Lim","doi":"10.1007/s11701-026-04017-w","DOIUrl":"10.1007/s11701-026-04017-w","url":null,"abstract":"<p><p>Robotic colorectal surgery is associated with longer operative times than conventional laparoscopic approaches, yet total operative duration is a composite measure comprising fundamentally different procedural components. It remains unknown as to whether postoperative morbidity is attributable to overall operative length or to specific phases of the robotic procedure. A retrospective single-centre cohort study at York and Scarborough NHS Foundation Trust, UK, included consecutive robotic colorectal resections performed by eight consultant surgeons (Surgeons A-H). Two prespecified cohorts were analysed: Cohort A (primary, N = 490) with complete knife-to-skin and case-completion timestamps; Cohort B (nested, N = 138) with complete intraoperative phase timestamps across six predefined phases. The primary outcome was a composite comprising prespecified postoperative complications, readmission and return to theatre within 30 days, plus all-cause mortality within 90 days. Multivariable binary logistic regression was used to examine associations with total operative duration; restricted cubic splines were used as an exploratory assessment of functional form. In Cohort A (N = 490), the primary composite endpoint occurred in 113 patients (23.1%). Median total operative time was 354 min (IQR 270-442). On multivariable analysis, each additional 30 min of operative duration was independently associated with increased odds of the composite endpoint (adjusted OR 1.08, 95% CI 1.01-1.17, p = 0.036). Greater within-programme cumulative case experience was associated with lower odds of morbidity (OR 0.82 per 10 additional cases, 95% CI 0.73-0.92, p < 0.001). In Cohort B (N = 138; 41 events), no individual operative phase reached statistical significance in the originally fitted adjusted phase models; these phase-level analyses are exploratory and should not be interpreted as evidence that any individual phase is unrelated to morbidity. A longer total operative duration was independently associated with our composite morbidity endpoints after adjustment for age, within-programme case experience, operating surgeon and procedure type. Within the smaller nested phase-timing cohort, no individual phase revealed a statistically significant independent association. These phase-level findings are exploratory and do not establish whether console or non-console components mediate the association observed with total operative duration.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative management and challenges of robotic-assisted surgery: a narrative review.","authors":"Yongjie Xu, Xinqiang Wang","doi":"10.1007/s11701-026-04012-1","DOIUrl":"https://doi.org/10.1007/s11701-026-04012-1","url":null,"abstract":"<p><p>Over the past two decades, robotic surgical technology has become increasingly widespread worldwide. RAS (robotic-assisted surgery) has attracted surgeons across various specialties with its advantages of high precision, a shorter learning curve, and reduced postoperative pain, while also imposing new requirements on the entire surgical team, including anesthesiologists. The physiological changes and unique complications associated with RAS have brought major challenges for anesthesiologists, who should respond rapidly to patient responses throughout the entire procedure.This review focuses on the potential issues encountered in the perioperative management of RAS, as well as the application of RAS across several specialties and the specific intraoperative management challenges involved.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of objective performance metrics for robot-assisted basic surgical skills in a simulated anastomosis task using a single-port robotic system.","authors":"Edoardo Beatrici, Valerio Santarelli, Alessio Guidotti, Francesco Pepillo, Mario de Angelis, Attilio Barretta, Francesco Cei, Nicola Frego, Marco Paciotti, Eva Vanderstraeten, Isabelle Van Herzeele, Stefano Puliatti, Geert De Naeyer, Rui Farinha, Ruben De Groote, Sij Hemal, Peter Wiklund, Simone Crivellaro, Ben Challacombe, Niki Rashidian, Alexandre Mottrie","doi":"10.1007/s11701-026-03996-0","DOIUrl":"https://doi.org/10.1007/s11701-026-03996-0","url":null,"abstract":"<p><strong>Introduction: </strong>The chicken anastomosis task is a widely adopted model for training robotic suturing and knot-tying. Aim of this study was to develop and validate objective performance metrics for this task on the Single-Port (SP) robotic platform and to establish a proficiency benchmark for training and assessment.</p><p><strong>Methods: </strong>Seven experts in robotic surgery training and Proficiency Based Progression (PBP) developed the metrics for the SP chicken anastomosis task. The proposed metrics were refined among a panel of n = 14 participants with significant experience in PBP and/or robotics and/or the SP system, through a modified Delphi process. Construct validity was assessed by comparing recorded performances of n = 12 expert ( ≥100 SP RARPs) and n = 12 novice surgeons, blindly scored by two reviewers. Proficiency benchmarks were established based on performance distribution.</p><p><strong>Results: </strong>Delphi consensus achieved 100% agreement on the proposed performance metrics (n = 5 steps, n = 20 errors, n = 1 failure to progress and n = 4 critical errors [CE]). Novices were twice more likely to commit a CE (n = 6 vs. n = 3). Among participants who completed the task without CEs, novices required significantly longer completion times (mean 25.3 min, 95%CI 18.0-32.7 vs. 11.2 min, 95%CI 8.5-13.9; p = 0.003) and committed a significantly higher mean number of errors (12.3, 95%CI 8.6-16.1 vs. 8.1, 95%CI 6.6-9.6, p = 0.033). Calculated Inter-Rater Reliability (IRR: agreements/agreements+disagreements) was 0.96. Proficiency benchmarks were defined as: absence of CEs and < 10 errors.</p><p><strong>Conclusions: </strong>The proposed metrics showed robust construct validity and reliability, and support PBP training and assessment for the SP platform. The proposed benchmark, as well as its clinical impact, requires confirmation and prospective evaluation.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The learning curve of robotic pancreatoduodenectomy: a systematic review of learning curve assessment methodologies, proficiency thresholds, training pathways and clinical outcomes.","authors":"Konstantinos Kossenas, Christoph Kuemmerli, Philip C Müller, Stylianos Kykalos, Felix Nickel, Nikolaos Machairas","doi":"10.1007/s11701-026-04025-w","DOIUrl":"10.1007/s11701-026-04025-w","url":null,"abstract":"<p><p>Robotic pancreatoduodenectomy (RPD) is one of the most technically challenging procedures in hepatopancreatobiliary surgery. Its adoption continues to grow, but the learning pathway to competency and mastery is still not fully defined. This systematic review aims to analyze the learning curve assessment methodologies, proficiency thresholds, training pathways, and influence of experience on perioperative and oncologic outcomes. This systematic review was conducted in accordance with PRISMA guidelines. PubMed/MEDLINE, Scopus and The Cochrane Library were systematically searched, from inception to June 2026. Due to large heterogeneity in study design, learning curve methodologies and outcome reporting, the data were synthesized narratively. Forty-two studies were included. The learning curve thresholds were 6-8 cases for initial competency and 250 + cases for mastery. Operative time suggested proficiency after 20-40 cases, whereas risk-adjusted results, textbook outcomes and composite quality measures suggested proficiency required 56-120 cases, with mastery only after 176-263 cases. Higher experience was associated with lower conversion rates, postoperative pancreatic fistula, delayed gastric emptying, major complications and mortality. Oncologic outcomes were stable or improved, with R0 resection rates generally exceeding 90% and lymph node harvest increasing from 17 to 26, 16 to 33, and 38 to 45.5 nodes in each phase despite increasing case complexity. The learning curve of RPD is a staged advancement and is affected by surgeon experience, institutional expertise, mentorship, training structure, and outcome definitions. Technical competence emerges after 20-40 cases, but achieving consistently high-quality outcomes and procedural mastery demands substantially broader surgical experience. Implementation of RPD is safe within competency-based assessment frameworks and structured training pathways.</p>","PeriodicalId":47616,"journal":{"name":"Journal of Robotic Surgery","volume":"20 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}