Robotic pancreaticoduodenectomy: Evidence, structured adoption, and the evolution of performance-based surgery

Robotic pancreaticoduodenectomy (RPD) has evolved over two decades from early feasibility reports to a rigorously studied operative platform supported by multi-institutional data and randomized trials. What began as a technical innovation has matured into a scalable and generalizable technique with demonstrated safety and oncologic integrity with defined performance benchmarks. However, the dissemination of complex procedures such as the RPD requires more than favorable outcomes alone. The learning curve, methods of training, and objective assessment of technical performance are central to responsible adoption. The robotic platform's ability to generate high-fidelity operative video has transformed how performance can be measured, creating opportunities for competency-based training, data-driven outcomes and ultimately real-time clinical decision support. This review summarizes contemporary evidence supporting RPD and examines how structured training, video-based assessment and emerging artificial intelligence-based approaches are shaping the next phase of its evolution.