• S George Barreto, Oliver Strobel, Roberto Salvia, Giovanni Marchegiani, Christopher L Wolfgang, Jens Werner, Cristina R Ferrone, Mohammed Abu Hilal, Ugo Boggi, Giovanni Butturini, Massimo Falconi, Carlos Fernandez-Del Castillo, Helmut Friess, Giuseppe K Fusai, Christopher M Halloran, Melissa Hogg, Jin-Young Jang, Jorg Kleeff, Keith D Lillemoe, Yi Miao, Yuichi Nagakawa, Masafumi Nakamura, Pascal Probst, Sohei Satoi, Ajith K Siriwardena, Charles M Vollmer, Amer Zureikat, Nicholas J Zyromski, Horacio J Asbun, Christos Dervenis, John P Neoptolemos, Markus W Büchler, Thilo Hackert, Marc G Besselink, Shailesh V Shrikhande, and International Study Group for Pancreatic Surgery.
• Department of Surgery, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia.
• Ann. Surg. 2025 Mar 1; 281 (3): 417429417-429.

ObjectiveTo develop a universally accepted complexity and experience grading system to guide the safe implementation of robotic and laparoscopic minimally invasive pancreatoduodenectomy (MIPD).BackgroundDespite the perceived advantages of MIPD, its global adoption has been slow due to the inherent complexity of the procedure and challenges to acquiring surgical experience. Its wider adoption must be undertaken with an emphasis on appropriate patient selection according to adequate surgeon and center experience.MethodsThe International Study Group for Pancreatic Surgery (ISGPS) developed a complexity and experience grading system to guide patient selection for MIPD based on an evidence-based review and a series of discussions.ResultsThe ISGPS complexity and experience grading system for MIPD is subclassified into patient-related risk factors and provider experience-related variables. The patient-related risk factors include anatomic (main pancreatic and common bile duct diameters), tumor-specific (vascular contact), and conditional (obesity and previous complicated upper abdominal surgery/disease) factors, all incorporated in an A-B-C classification, graded as no, a single, and multiple risk factors. The surgeon and center experience-related variables include surgeon total MIPD experience (cutoffs 40 and 80) and center annual MIPD volume (cutoffs 10 and 30), all also incorporated in an A-B-C classification.ConclusionsThis ISGPS complexity and experience grading system for robotic and laparoscopic MIPD may enable surgeons to optimally select patients after duly considering specific risk factors known to influence the complexity of the procedure. This grading system will likely allow for a thoughtful and stepwise implementation of MIPD and facilitate a fair comparison of outcomes between centers and countries.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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