Achieving Textbook Outcomes After Robotic Pancreatic Enucleation: A Two-Center Assessment of an Optimal Perioperative Pathway

By
Marionna Cathomas
Zheng Li
Benedict Kinny-Köster
Bo Kong
Ingmar Rompen
Elias Gauer
Miriam Klauß
Christoph W. Michalski
Martin Loos
Jin He
Thomas Hank
October 7, 2026

Surgical Endoscopy

Overview

This retrospective two-center study proposes a procedure-specific textbook outcome for robotic pancreatic enucleation (rPE-TO), combining six perioperative and procedure-specific criteria. The supplied material describes the study design and outcome definition but does not provide cohort sizes, outcome rates, or factors associated with achieving rPE-TO.

Background

Robotic pancreatic enucleation is used as a parenchyma-sparing approach for benign and low-grade malignant pancreatic lesions, with the aim of removing the lesion while preserving pancreatic function. The procedure is technically demanding and is associated with procedure-specific morbidity, particularly clinically relevant postoperative pancreatic fistula. Textbook outcome measures combine multiple perioperative endpoints, but the source notes that no composite measure had been defined specifically for pancreatic enucleation. The study therefore developed and assessed a measure incorporating both established surgical quality indicators and criteria specific to the goals of rPE.

Data Highlights

Measure	Study definition or design
Study design	Retrospective, two-center cohort study
Heidelberg cohort period	April 2023–March 2025
Johns Hopkins cohort period	September 2017–October 2025
rPE-TO criteria	All six criteria required: no conversion to open surgery; complete resection without reoperation; no clinically relevant postoperative pancreatic fistula; no major complication (Clavien–Dindo grade ≥IIIa); no readmission within 30 days; survival through 90 days
Analysis plan	Independent cohort assessment and pooled multivariable analysis adjusted for center

Key Findings

The proposed rPE-TO was designed to represent an ideal perioperative course after robotic pancreatic enucleation.
It combines four established postoperative quality indicators—major morbidity, clinically relevant pancreatic fistula, readmission, and mortality—with procedure-specific criteria for completing the planned minimally invasive operation and removing the lesion completely.
All six components must be met; failure of any single component precludes classification as rPE-TO.
The study included completed robotic enucleations for benign or low-grade malignant pancreatic lesions at Heidelberg University Hospital and Johns Hopkins University.
The investigators planned to assess applicability in each institutional cohort and to examine determinants of rPE-TO failure using a pooled multivariable analysis adjusted for center.
The supplied article excerpt does not report cohort sizes, rPE-TO achievement rates, or results of the multivariable analysis.

Clinical Implications

The study sought to develop a textbook outcome specific to robotic pancreatic enucleation and assess its applicability in two institutional cohorts. The supplied material does not report outcome rates or factors associated with achieving rPE-TO.

Conclusion

The study defines a six-component textbook outcome tailored to robotic pancreatic enucleation and evaluates its use across two institutional cohorts. The available source material describes the methods but not the results.