Applying the Delphi process for development of a hepatopancreaticobiliary robotic surgery training curriculum

Yuman Fong*, Joseph F. Buell, Justin Collins, John Martinie, Christiane Bruns, Allan Tsung, Pierre Alain Clavien, Ido Nachmany, Bjørn Edwin, Johann Pratschke, Evgeny Solomonov, Alfred Koenigsrainer, Pier Cristoforo Giulianotti

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Robotic hepatopancreaticobiliary (HPB) procedures are performed worldwide and establishing processes for safe adoption of this technology is essential for patient benefit. We report results of the Delphi process to define and optimize robotic training procedures for HPB surgeons. Methods: In 2019, a robotic HPB surgery panel with an interest in surgical training from the Americas and Europe was created and met. An e-consensus–finding exercise using the Delphi process was applied and consensus was defined as 80% agreement on each question. Iterations of anonymous voting continued over three rounds. Results: Members agreed on several points: there was need for a standardized robotic training curriculum for HPB surgery that considers experience of surgeons and based on a robotic hepatectomy includes a common approach for “basic robotic skills” training (e-learning module, including hardware description, patient selection, port placement, docking, troubleshooting, fundamentals of robotic surgery, team training and efficiency, and emergencies) and an “advanced technical skills curriculum” (e-learning, including patient selection information, cognitive skills, and recommended operative equipment lists). A modular approach to index procedures should be used with video demonstrations, port placement for index procedure, troubleshooting, and emergency scenario management information. Inexperienced surgeons should undergo training in basic robotic skills and console proficiency, transitioning to full procedure training of e-learning (video demonstration, simulation training, case observation, and final evaluation). Experienced surgeons should undergo basic training when using a new system (e-learning, dry lab, and operating room (OR) team training, virtual reality modules, and wet lab; case observations were unnecessary for basic training) and should complete the advanced index procedural robotic curriculum with assessment by wet lab, case observation, and OR team training. Conclusions: Optimization and standardization of training and education of HPB surgeons in robotic procedures was agreed upon. Results are being incorporated into future curriculum for education in robotic surgery.

Original languageEnglish
Pages (from-to)4233-4244
Number of pages12
JournalSurgical Endoscopy and Other Interventional Techniques
Issue number10
StatePublished - 1 Oct 2020


  • Consensus
  • E-learning
  • HPB surgery
  • Robotic
  • Surgical education
  • Virtual reality


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