The Brescia Internationally Validated European Guidelines on Minimally Invasive Pancreatic Surgery (EGUMIPS)
Authors: Abu Hilal Mohammad , van Ramshorst Tess M.E. , Boggi Ugo , Dokmak Safi , Edwin Bjørn , Keck Tobias , Khatkov Igor , Ahmad Jawad , Al Saati Hani , Alseidi Adnan , Azagra Juan S. , Björnsson Bergthor , Can Fatih M. , D’Hondt Mathieu , Efanov Mikhail , Alvarez Francisco Espin , Esposito Alessandro , Ferrari Giovanni , Koerkamp Bas Groot , Gumbs Andrew A. , Hogg Melissa E. , Huscher Cristiano G.S. , Ielpo Benedetto , Ivanecz Arpad , Jang Jin-Young , Liu Rong , Luyer Misha D.P. , Menon Krishna , Nakamura Masafumi , Piardi Tullio , Saint-Marc Olivier , White Steve , Yoon Yoo-Seok , Zerbi Alessandro , Bassi Claudio , Berrevoet Frederik , Chan Carlos , Coimbra Felipe J. , Conlon Kevin C.P. , Cook Andrew , Dervenis Christos , Falconi Massimo , Ferrari Clarissa , Frigerio Isabella , Fusai Giuseppe K. , De Oliveira Michelle L. , Pinna Antonio D. , Primrose John N. , Sauvanet Alain , Serrablo Alejandro , Smadi Sameer , Badran Ali , Baychorov Magomet , Bannone Elisa , van Bodegraven Eduard A. , Emmen Anouk M.L.H. , Giani Alessandro , de Graaf Nine , van Hilst Jony , Jones Leia R. , Sandri Giovanni B. Levi , Pulvirenti Alessandra , Ramera Marco , Rashidian Niki , Sahakyan Mushegh A. , Uijterwijk Bas A. , Zampedri Pietro , Zwart Maurice J.W. , Alfieri Sergio , Berti Stefano , Butturini Giovanni , Di Benedetto Fabrizio , Ettorre Giuseppe M. , Giuliante Felice , Jovine Elio , Memeo Riccardo , Portolani Nazario , Ruzzenente Andrea , Salvia Roberto , Siriwardena Ajith K. , Besselink Marc G. , Asbun Horacio J. ,   Collaborators
Published: July 2023

Objective:
To develop and update evidence- and consensus-based guidelines on laparoscopic and robotic pancreatic surgery.

Summary Background Data:
Minimally invasive pancreatic surgery (MIPS), including laparoscopic and robotic surgery, is complex and technically demanding. Minimizing the risk for patients requires stringent, evidence-based guidelines. Since the International Miami Guidelines on MIPS in 2019, new developments and key publications have been reported, necessitating an update.

Methods:
Evidence-based guidelines on 22 topics in 8 domains were proposed: terminology, indications, patients, procedures, surgical techniques and instrumentation, assessment tools, implementation and training, and artificial intelligence. The Brescia Internationally Validated European Guidelines on Minimally Invasive Pancreatic Surgery (EGUMIPS, September 2022) used the Scottish Intercollegiate Guidelines Network (SIGN) methodology to assess the evidence and develop guideline recommendations, the Delphi method to establish consensus on the recommendations among the Expert Committee, the AGREE II-GRS tool for methodological guideline quality assessment, and external validation by a Validation Committee.

Results:
Overall, 27 European experts, 6 international experts, 22 international Validation Committee members, 11 Jury Committee members, 18 Research Committee members, and 121 registered attendees of the two-day meeting were involved in the development and validation of the guidelines. In total, 98 recommendations were developed, including 33 on laparoscopic, 34 on robotic and 31 on general MIPS covering 22 topics in 8 domains. Out of 98 recommendations, 97 reached at least 80% consensus among the experts and congress attendees, and all recommendations were externally validated by the Validation Committee.

Conclusions:
The EGUMIPS evidence-based guidelines on laparoscopic and robotic MIPS can be applied in current clinical practice to provide guidance to patients, surgeons, policy-makers and medical societies.