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The implementation of a robotic surgical platform for the treatment of patients with malignant or pre-malignant pancreatic tumors at the University Medical Center Ljubljana Cover

The implementation of a robotic surgical platform for the treatment of patients with malignant or pre-malignant pancreatic tumors at the University Medical Center Ljubljana

Open Access
|Sep 2025

References

  1. Hays SB, Rojas AE, Hogg ME. Robotic pancreas surgery for pancreatic cancer. Int J Surg 2024; 110: 6100-10. doi: 10.1097/JS9.0000000000000906
  2. Roulin D, McCarron FN, Chirichella TJ, Martinieet JB. Robotic pancreatic surgery: current status and techniques. Curr Surg Rep 2024; 12: 1-7. doi: 10.1007/s40137-023-00381-w
  3. Zhang T, Zhao ZM, Gao YX, Lau WY, Liu R. The learning curve for a surgeon in robot-assisted laparoscopic pancreaticoduodenectomy: a retrospective study in a high-volume pancreatic center. Surg Endosc 2019; 33: 2927-33. doi: 10.1007/s00464-018-6595-0
  4. Shyr BU, Chen SC, Shyr YM, Wang SE. Learning curves for robotic pancreatic surgery-from distal pancreatectomy to pancreaticoduodenectomy. Medicine 2018; 97: e13000. doi: 10.1097/MD.0000000000013000
  5. Shakir M, Boone BA, Polanco PM, Zenati MS, Hogg ME, Tsung A, et al. The learning curve for robotic distal pancreatectomy: an analysis of outcomes of the first 100 consecutive cases at a high-volume pancreatic centre. HPB (Oxford) 2015; 17: 580-6. doi: 10.1111/hpb.12412
  6. Müller-Debus CF, Thomaschewski M, Zimmermann M, Wellner UF, Bausch D, Keck T. Robot-assisted pancreatic surgery: a structured approach to standardization of a program and of the operation. Visc Med 2020; 36: 104-12. doi: 10.1159/000506909
  7. Torphy RJ, Fujiwara Y, Schulick RD. Pancreatic cancer treatment: better, but a long way to go. Surg Today 2020; 50: 1117-25. doi: 10.1007/s00595-020- 02028-0
  8. Augustinus S, Mackay TM, Andersson B, Beane JD, Busch OR, Gleeson EM, et al. Ideal outcome after pancreatoduodenectomy: a transatlantic evaluation of a harmonized composite outcome measure. Ann Surg 2023; 278: 740-7. doi: 10.1097/SLA.0000000000006037
  9. Russell TB, Aroori S. Procedure-specific morbidity of pancreatoduodenectomy: a systematic review of incidence and risk factors. ANZ J Surg 2022; 92: 1347-55. doi: 10.1111/ans.17473
  10. Ayasun R, Saridogan T, Gaber O, Sahin IH. Systemic therapy for patients with pancreatic cancer: current approaches and opportunities for novel avenues toward precision medicine. Clin Colorectal Cancer 2023; 22: 2-11. doi: 10.1016/j.clcc.2022.11.001
  11. Dulan G, Rege RV, Hogg DC, Gilberg-Fisher KM, Arain NA, Tesfay ST, et al. Developing a comprehensive, proficiency-based training program for robotic surgery. Surgery 2012; 152: 477-88. doi: 10.1016/j.surg.2012.07.028
  12. Radi I, Tellez JC, Alterio RE, Scott DJ, Sankaranarayanan G, Nagaraj MB, et al. Feasibility, effectiveness and transferability of a novel mastery-based virtual reality robotic training platform for general surgery residents. Surg Endosc 2022; 36: 7279-87. doi: 10.1007/s00464-022-09106-z
  13. Martin JA, Regehr G, Reznick R, MacRae H, Murnaghan J, Hutchison C, et al. Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 1997; 84: 273-8. doi: 10.1046/j.1365-2168.1997.02502.x
  14. Rail B, Abreu AA, Farah E, Scott DJ, Sankaranarayanan G, Zeh HJ 3rd, et al. Learning curve of a robotic bio-tissue intestinal anastomosis: implications for surgical training curricula. J Surg Educ 2024; 81: 103296. doi: 10.1016/j. jsurg.2024.09.015
  15. Al Abbas AI, Zeh Iii HJ, Polanco PM. State of the art robotic distal pancreatectomy: a review of the literature. Updates Surg 2021; 73: 881-91. doi: 10.1007/s13304-021-01070-y
  16. Giulianotti PC, Mangano A, Bustos RE, Gheza F, Fernandes E, Masrur MA, et al. Operative technique in robotic pancreaticoduodenectomy (RPD) at University of Illinois at Chicago (UIC): 17 steps standardized technique: lessons learned since the first worldwide RPD performed in the year 2001. Surg Endosc 2018; 32: 4329-36. doi: 10.1007/s00464-018-6228-7
  17. Inoue Y, Sato T, Kato T, Oba A, Ono Y, Mise Y, et al. Reproduction of modified Blumgart pancreaticojejunostomy in a robotic environment: a simple clipless technique. Surg Endosc 2022; 36: 8684-9. doi: 10.1007/s00464- 022-09397-2
  18. Søreide K. A formula for survival in surgery. Patient Saf Surg 2023; 17: 13. doi: 10.1186/s13037-023-00362-z
  19. Fernandes E, Giulianotti PC. Robotic-assisted pancreatic surgery. J Hepatobiliary Pancreat Sci 2013; 20: 583-9. doi: 10.1007/s00534-013- 0615-1
  20. Asbun HJ, Moekotte AL, Vissers FL, Kunzler F, Cipriani F, Alseidi A, et al. The Miami international evidence-based guidelines on minimally invasive pancreas resection. Ann Surg 2020; 271: 1-14. doi: 10.1097/SLA.0000000000003590
  21. Abu Hilal M, van Ramshorst TME, Boggi U, Dokmak S, Edwin B, Keck T, et al. The Brescia internationally validated european guidelines on minimally invasive pancreatic surgery (EGUMIPS). Ann Surg 2024; 279: 45-57. doi: 10.1097/SLA.0000000000006006
  22. Niu X, Yu B, Yao L, Tian J, Guo T, Ma S, et al. Comparison of surgical outcomes of robot-assisted laparoscopic distal pancreatectomy versus laparoscopic and open resections: a systematic review and meta-analysis. Asian J Surg 2019; 42: 32-45. doi: 10.1016/j.asjsur.2018.08.011
  23. Zhao W, Liu C, Li S, Geng D, Feng Y, Sun M. Safety and efficacy for robot-assisted versus open pancreaticoduodenectomy and distal pancreatectomy: a systematic review and meta-analysis. Surg Oncol 2018; 27: 468-78. doi: 10.1016/j.suronc.2018.06.001
  24. Vining CC, Kuchta K, Berger Y, Paterakos P, Schuitevoerder D, Roggin KK, et al. Robotic pancreaticoduodenectomy decreases the risk of clinically relevant post-operative pancreatic fistula: a propensity score matched NSQIP analysis. HPB (Oxford) 2021; 23: 367-78. doi: 10.1016/j.hpb.2020.07.004
  25. Da Dong X, Felsenreich DM, Gogna S, Rojas A, Zhang E, Dong M, et al. Robotic pancreaticoduodenectomy provides better histopathological outcomes as compared to its open counterpart: a meta-analysis. Sci Rep 2021; 11: 3774. doi: 10.1038/s41598-021-83391-x
  26. Zureikat AH, Beane JD, Zenati MS, Al Abbas AI, Boone BA, Moser AJ, et al. 500 minimally invasive robotic pancreatoduodenectomies: one decade of optimizing performance. Ann Surg 2021; 273: 966-72. doi: 10.1097/SLA.0000000000003550
  27. Bencini L, Moraldi L, Miceli E, Risaliti M, Tofani L, Buccianti S, et al. Robotic versus open distal pancreatectomy: a propensity score matching analysis. Int J Med Robot 2024; 20: e70025. doi: 10.1002/rcs.70025
  28. Korrel M, Jones LR, van Hilst J, Balzano G, Björnsson B, Boggi U, et al. Minimally invasive versus open distal pancreatectomy for resectable pancreatic cancer (DIPLOMA): an international randomised non-inferiority trial. Lancet Reg Health Eur 2023; 31: 100673. doi: 10.1016/j.lanepe.2023.100673
  29. Korrel M, van Hilst J, Bosscha K, Busch ORC, Daams F, van Dam R, et al. Nationwide use and outcome of minimally invasive distal pancreatectomy in IDEAL Stage IV following a training program and randomized trial. Ann Surg 2024; 279: 323-30. doi: 10.1097/SLA.0000000000005900
  30. Vining CC, Hogg ME. How to train and evaluate minimally invasive pancreas surgery. J Surg Oncol 2020; 122: 41-8. doi: 10.1002/jso.25912
  31. Santok GD, Raheem AA, Kim LH, Chang K, Chung BH, Choi YD, et al. Proctorship and mentoring: its backbone and application in robotic surgery. Investig Clin Urol 2016; 57(Suppl 2): S114-20. doi: 10.4111/icu.2016.57. S2.S114
  32. Radi I, Tellez JC, Alterio RE, Scott DJ, Sankaranarayanan G, Nagaraj MB, et al. Feasibility, effectiveness and transferability of a novel mastery-based virtual reality robotic training platform for general surgery residents. Surg Endosc 2022; 36: 7279-87. doi: 10.1007/s00464-022-09106-z
  33. Abreu AA, Rail B, Farah E, Alterio RE, Scott DJ, Sankaranarayanan G, et al. Baseline performance in a robotic virtual reality platform predicts rate of skill acquisition in a proficiency-based curriculum: a cohort study of surgical trainees. Surg Endosc 2023; 37: 8804-9. doi: 10.1007/s00464-023-10372-8
  34. Karadza E, Haney CM, Limen EF, Müller PC, Kowalewski KF, Sandini M, et al. Development of biotissue training models for anastomotic suturing in pancreatic surgery. HPB (Oxford) 2023; 25: 625-35. doi: 10.1016/j. hpb.2023.02.002
  35. Cumpanas AA, Bardan R, Ferician OC, Latcu SC, Duta C, Lazar FO. Does previous open surgical experience have any influence on robotic surgery simulation exercises? Wideochir Inne Tech Maloinwazyjne 2017; 12: 366-71. doi: 10.5114/wiitm.2017.72320
  36. Chahal B, Aydın A, Amin MSA, Ong K, Khan A, Khan MS, et al. Transfer of open and laparoscopic skills to robotic surgery: a systematic review. J Robot Surg 2023; 17: 1207-25. doi: 10.1007/s11701-022-01492-9
  37. Boone BA, Zenati M, Hogg ME, Steve J, Moser AJ, Bartlett DL, et al. Assessment of quality outcomes for robotic pancreaticoduodenectomy: identification of the learning curve. JAMA Surg 2015; 150: 416-22. doi: 10.1001/jamasurg.2015.17
  38. Chen S, Chen JZ, Zhan Q, Deng XX, Shen BY, Peng CH, et al. Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study. Surg Endosc 2015; 29: 3698-711. doi: 10.1007/s00464-015-4140-y
  39. Napoli N, Kauffmann EF, Palmeri M, Miccoli M, Costa F, Vistoli F, et al. The learning curve in robotic pancreaticoduodenectomy. Dig Surg 2016; 33: 299-307. doi: 10.1159/000445015
  40. Benizri EI, Germain A, Ayav A, Bernard JL, Zarnegar R, Benchimol D, et al. Short-term perioperative outcomes after robot-assisted and laparoscopic distal pancreatectomy. J Robot Surg 2014; 8: 125-32. doi: 10.1007/s11701- 013-0438-8
  41. Fung G, Sha M, Kunduzi B, Froghi F, Rehman S, Froghi S. Learning curves in minimally invasive pancreatic surgery: a systematic review. Langenbecks Arch Surg 2022; 407: 2217-32. doi: 10.1007/s00423-022-02470-3
  42. Zwart MJW, Nota CLM, de Rooij T, van Hilst J, Te Riele WW, van Santvoort HC, et al. Outcomes of a multicenter training program in robotic pancreatoduodenectomy (LAELAPS-3). Ann Surg 2022; 276: e886-95. doi: 10.1097/SLA.0000000000004783
  43. Zwart MJW, van den Broek B, de Graaf N, Suurmeijer JA, Augustinus S, Te Riele WW, et al. The feasibility, proficiency, and mastery learning curves in 635 robotic pancreatoduodenectomies following a multicenter training program: “Standing on the shoulders of giants”. Ann Surg 2023; 278: e1232-41. doi: 10.1097/SLA.0000000000005928
  44. Farrugia A, Muhammad QR, Ravichandran NT, Ali M, Marangoni G, Ahmad J. Proposed training pathway with initial experience to set up robotic hepatobiliary and pancreatic service. J Robot Surg 2022; 16: 65-71. doi: 10.1007/s11701-021-01207-6
  45. Dall’Olio T, Perri G, Reese T, Sparrelid E, Gilg S. Implementation of a robotic hepato-pancreato-biliary surgery program: a Swedish referral center’s experience. J Robot Surg 2025; 19: 101. doi: 10.1007/s11701-025-02241-4
  46. Wang J, Lu P, Armstrong M, El-Hayek K, Cleary S, Asbun H, et al. Advancing minimally invasive hepato-pancreato-biliary surgery: ensuring safety with implementation. Surg Endosc 2024; 38: 4365-73. doi: 10.1007/s00464- 024-10957-x
  47. Takagi K, Umeda Y, Yoshida R, Yagi T, Fujiwara T, Zureikat AH, et al. Surgical training model and safe implementation of robotic pancreatoduodenectomy in Japan: a technical note. World J Surg Oncol 2021; 19: 55. doi: 10.1186/s12957-021-02167-9
  48. Søreide JA, Sandvik OM, Søreide K. Improving pancreas surgery over time: performance factors related to transition of care and patient volume. Int J Surg 2016; 32: 116-22. doi: 10.1016/j.ijsu.2016.06.046
  49. Panni RZ, Panni UY, Liu J, Williams GA, Fields RC, Sanford DE, et al. Redefining a high volume center for pancreaticoduodenectomy. HPB (Oxford) 2021; 23: 733-8. doi: 10.1016/j.hpb.2020.09.009
  50. Latenstein AEJ, Mackay TM, van der Geest LGM, van Eijck CHJ, de Meijer VE, Stommel MWJ, et al. Effect of centralization and regionalization of pancreatic surgery on resection rates and survival. Br J Surg 2021; 108: 826-33. doi: 10.1093/bjs/znaa146
  51. Wu CH, Chien KL, Lin JW, Tien YW. Superior surgical outcomes in high-volume centers despite longer waiting times for curative pancreatic surgery compared to shorter waits in low-volume centers: a population-based study. Curr Probl Surg 2025; 62: 101674. doi: 10.1016/j.cpsurg.2024.101674
  52. Sinyard RD, Rentas CM, Gunn EG, Etheridge JC, Robertson JM, Gleason A, et al. Managing a team in the operating room: the science of teamwork and non-technical skills for surgeons. Curr Probl Surg. 2022; 59: 101172. doi: 10.1016/j.cpsurg.2022.101172
  53. Mahendran V, Turpin L, Boal M, Francis NK. Assessment and application of non-technical skills in robotic-assisted surgery: a systematic review. Surg Endosc 2024; 38: 1758-74. doi: 10.1007/s00464-024-10713-1
DOI: https://doi.org/10.2478/raon-2025-0051 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
Language: English
Page range: 425 - 434
Submitted on: Apr 30, 2025
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Accepted on: Jun 27, 2025
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Published on: Sep 5, 2025
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2025 Miha Petric, Patricio Marcelo Polanco, Jan Grosek, Ales Tomazic, Blaz Trotovsek, Bostjan Plesnik, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.