Defining the Learning Curve for Team-Based Laparoscopic Pancreaticoduodenectomy

Speicher, Paul J.; Nussbaum, Daniel P.; White, Rebekah R.; Zani, Sabino; Mosca, Paul J.; Blazer, Dan G.; Clary, Bryan M.; Pappas, Theodore N.; Tyler, Douglas S.; Perez, Alexander

doi:10.1245/s10434-014-3839-7

Cited by 169 publications

(120 citation statements)

References 14 publications

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“…The learning curve of LPD was identified in several studies published before (1,(17)(18)(19) (19) also indicated decreased OT and EBL during learning curve, and proposed a staged learning process to surmount learning curve. They believed that learning curve for LPD consisted of a slow and difficult beginning phase, a steep acceleration phase, and finally a plateau phase with slower but continuous improvements.…”

Section: Discussionmentioning

confidence: 97%

Analysis of learning curve for laparoscopic pancreaticoduodenectomy

Lü¹,

Jin²,

Mou³

et al. 2016

J. Vis. Surg.

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Section: Discussionmentioning

confidence: 97%

Analysis of learning curve for laparoscopic pancreaticoduodenectomy

Lü¹,

Jin²,

Mou³

et al. 2016

J. Vis. Surg.

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“…In laparoscopic pancreaticoduodenectomy, Speicher et al [28] reported that 50 cases were required to achieve reduction in OT and blood loss as compared with the open approach.…”

Section: Discussionmentioning

confidence: 99%

The Learning Curve in Robotic Pancreaticoduodenectomy

Napoli¹,

Kauffmann²,

Palmeri³

et al. 2016

Dig Surg

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Background/Purpose: Few data are available on the learning curve (LC) in robot-assisted pancreaticoduodenectomy (RAPD) and no study specifically addresses the LC of a single surgeon. Methods: The LC of a single surgeon in RAPD was determined using the cumulative sum method, based on operative time (OT). Data were extracted from a prospectively maintained database and analyzed retrospectively considering all events occurring within 90 days of index operation. Results: Seventy RAPD were analyzed. One operation was converted to open surgery (1.4%). One patient died within 30 days (1.4%) and one within 90 days (2.8%). Postoperative complications occurred in 53 patients (75.7%) and exceeded Clavien-Dindo grade IIIb in 7 patients (10%). OT dropped after 33 operations from a mean of 564 ± 101.7 min to a mean of 484.1 ± 77.9 min (p = 0.0005) and was associated to reduced incidence of delayed gastric emptying (72.7 vs. 48.7%; p = 0.039). The rate of hospital readmission improved after 40 operations from 20.0 (8 of 40) to 3.3% (1 of 30) (p = 0.04). Conclusions: RAPD was safely feasible in selected patients. OT dropped after the first 33 operations and was associated with reduced rate of delayed gastric emptying. Readmission rate improved after 40 operations.

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“…Since then, several single institution series reported on the safety and feasibility of TLP in the setting of several benign and malignant pancreatic pathologies (2)(3)(4). The available literature mainly focuses on two key aspects of TLP, one being the learning curve necessary to master the procedure and the other being the comparison of overall outcomes between TLP and open pancreaticoduodenectomy (OPD) (5)(6)(7). The numerous studies that have focused on TLP learning curve have identified at least three phases: a slow difficult beginning, followed by a rapid improvement that culminates in a plateau phase characterized by a slow but continuous improvement (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

“…The available literature mainly focuses on two key aspects of TLP, one being the learning curve necessary to master the procedure and the other being the comparison of overall outcomes between TLP and open pancreaticoduodenectomy (OPD) (5)(6)(7). The numerous studies that have focused on TLP learning curve have identified at least three phases: a slow difficult beginning, followed by a rapid improvement that culminates in a plateau phase characterized by a slow but continuous improvement (5)(6)(7). Moreover, most studies comparing TLP to OPD suggest that when TLP is performed in center of expertise the oncologic outcome, the complication rate, and the mortality rate are similar to OPD.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, most studies comparing TLP to OPD suggest that when TLP is performed in center of expertise the oncologic outcome, the complication rate, and the mortality rate are similar to OPD. Furthermore, TLP appears to be associated with decreased blood loss and hospital stay despite being associated with longer operative time (7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

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Total laparoscopic pancreaticoduodenectomy

et al. 2016

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Total laparoscopic pancreaticoduodenectomy (TLP) represents perhaps one of the most challenging abdominal operations. This procedure is gaining popularity in recent years, mostly due to the numerous reports underling its safety and feasibility in the setting of several benign and malignant pancreatic pathologies. Minimal-invasive pancreatic surgery is rapidly becoming a reality in many centers around the globe and its benefits, compared to the traditional open approach, have been extensively proven in the setting of distal pancreatic resection. The many advantages of a laparoscopic approach, such as the improved visual magnification, the theoretical improved tissue exposure, and the potential for a more delicate manipulation of tissues are reasonably expected to be applicable to other pancreatic procedures including TLP. Herein we describe a technique for a TLP; we provide some suggestions on patient selection, pre-operative preparation, equipment, postoperative management, and finally discuss some of the most common pitfalls encountered during the procedure. preparation, equipment, postoperative management, and finally discuss some of the most common pitfalls encountered during the procedure. Patient selection and workupMost patients with pancreatic, ampullary, or biliary pathologies who require a pancreaticoduodenectomy are eligible for a laparoscopic approach. One limitation is represented by patients with locally advanced pathologies (i.e., locally advanced pancreatic adenocarcinoma) with involvement of the mesenteric vasculature due to the inherent technical difficulties represented by the need for laparoscopic vascular resection and reconstruction (although a few specialized centers occasionally offer TLP in this setting) (11,19).The authors routinely obtain preoperative multi-slice pancreas specific triple-phase (i.e., arterial, late arterial, and venous phase) computed tomography in order to properly evaluate the pancreatic gland and its spatial relation with the surrounding organs and vasculature; particular attention is given to the evaluation for any aberrant anatomy (e.g., replaced or accessory hepatic vasculature).Additional imaging is dictated by the particular pancreatic pathology that is being addressed, and can vary from endoscopic retrograde cholangiopancreatography with or without pancreatic duct brushing, endoscopic pancreatic ultrasound with or without fine needle aspiration, and magnetic resonance imaging.Preoperative laboratory tests are routinely obtained and include a complete blood cell count, a complete metabolic panel (CMP), a coagulation profile, and in case of a patient with known preexisting diabetes glycated hemoglobin level is assessed; specific tumors markers are obtained based on the pathology being treated. Pre-operative preparationPatients selected to undergo a TLP meet preoperatively with a nutritionist and a glucose management expert, this provides an initial overview on the life style and diet adjustments that are necessary following the procedure. Furthermore, t...

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Defining the Learning Curve for Team-Based Laparoscopic Pancreaticoduodenectomy

Cited by 169 publications

References 14 publications

Analysis of learning curve for laparoscopic pancreaticoduodenectomy

Analysis of learning curve for laparoscopic pancreaticoduodenectomy

The Learning Curve in Robotic Pancreaticoduodenectomy

Total laparoscopic pancreaticoduodenectomy

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