Setting the Standard in Robotic Whipple Surgery: International Multicenter Benchmark Analysis

Area of Science:

• Surgical Innovation
• Robotic Surgery
• Gastrointestinal Surgery

Background:

• Robust quality control is crucial for adopting new surgical techniques like robotic Whipple.
• International consensus prioritizes establishing benchmark values for robotic Whipple procedures.
• Benchmarking is a proven method for evaluating surgical performance and ensuring patient safety.

Purpose of the Study:

• To establish the first international benchmark values for key outcome parameters in robotic Whipple surgery.
• To provide a standardized framework for assessing the quality and safety of robotic Whipple procedures globally.

Main Methods:

• Analysis of consecutive robotic Whipple patients (2020-2023) from 12 international reference centers with ≥1 year follow-up.
• Reference centers met criteria for high caseload (≥15 cases/year), scientific activity, and prospective data collection.
• Benchmarks established for 13 outcome parameters, excluding specific complex cases (e.g., neoadjuvant therapy, arterial resection).

Main Results:

• A cohort of 418 patients from 12 centers defined benchmarks: conversion rate ≤4.3%, transfusion rate ≤2.1%, 6-month mortality ≤2.2%, major complications ≤23.2%.
• Key complication benchmarks include pancreatic fistula (grade B/C) ≤23.6% and hemorrhage (grade B/C) ≤12.7%.
• Higher surgical difficulty correlated with increased morbidity; higher center caseload linked to reduced pancreas-specific complications.

Conclusions:

• This study presents the first international benchmarks for robotic Whipple surgery.
• Robotic Whipple demonstrates oncologic outcomes and morbidity comparable to open surgery.
• These benchmarks facilitate quality assessment and support the safe adoption of minimally invasive Whipple procedures.