Learning Curve for Laparoscopic Pancreaticoduodenectomy: a CUSUM Analysis

Abstract

According to this study, the learning curve for LPD consisted of three phases. Conservatively, to attain technical competence for performing LPD, a minimum of 40 cases are required for laparoscopic surgeons with a degree of laparoscopic experience.

Learning curve and surgical factors influencing the surgical outcomes during the initial experience with laparoscopic pancreaticoduodenectomy

“…Wang et al. also used CUSUM analysis and showed a similar learning curve with LPD at a single institution. They concluded that a minimum of 40 cases is required to achieve a certain degree of LPD experience.…”

First experience with robotic pancreatoduodenectomy in Singapore

“…(1) This data is unsurprising, as other studies have estimated that the learning curve for RPD is shorter than that for LPD, primarily due to the ease of learning the anastomotic skills required in PD with the robotic platform. (33,46,47) These results are important; as a recent study published by Kutlu et al demonstrated, the advantages of LPD such as shorter hospital stay and lower readmission rate only become apparent in high-volume institutions (> 25 cases per year). (48) Not unexpectedly, lower PD case volumes correlated with poorer outcomes regardless of surgical approach.…”

Laparoscopic pancreaticoduodenectomy in Brisbane, Australia: an initial experience

“…Recent publications from China and the USA have suggested an initial hurdle of approximately 10 cases where excess morbidity is likely, but up to 40-50 cases were required to achieve reductions in operating time and blood loss. 10,11 Important performance indicators for PD include blood loss, operative time, margin status, post-operative pancreatic fistula, re-operation/intervention and perioperative mortality. In this series, median blood loss was low (400 mL) as were transfusion rates (8%).…”