Learning Curve in Laparoscopic Pancreaticoduodenectomy: Using Risk-Adjusted Cumulative Summation Methods

Analysis of the learning curve for laparoscopic pancreaticoduodenectomy based on a single surgeon’s experience: a retrospective observational study

“…The Kocherization technique was learned from stomach surgeries. Recent studies that evaluated the learning curve for LPD with CUSUM and RA-CUSUM analysis reported that 30–60 cases are required to overcome the learning curve for LPD [ 3 4 5 6 7 8 ]. The present study demonstrated a similar result (44 cases) for the stabilization of LPD performance.…”

“…The learning curve for LPD was analyzed using CUSUM and RA-CUSUM methods [ 3 4 5 7 ]. CUSUM-OT was defined as the summation of the difference of time in minutes between the operation time of each case and the mean operation time of all cases.…”

“…Consequently, the learning curve for LPD is steep and varies based on the expertise and experience of the operator and the volume at the center. Several studies reported that 30–60 cases are required to overcome the learning curve for LPD [ 3 4 5 6 7 8 ]. This study aimed to analyze the learning curve of a single surgeon for LPD using cumulative summation (CUSUM) analysis and risk-adjusted CUSUM (RA-CUSUM) analysis methods.…”

Evolution of laparoscopic pancreaticoduodenectomy at Westmead Hospital

“…The minimum number of cases to overcome the initial learning curve has been reported to be around 20, but the minimum number of cases to achieve proficiency of TLPD is likely to be closer to 50-100. [20][21][22] Important aspects of the learning curve should incorporate not only a plateauing of operative times and improvement of safe surgical technique, but also achieving optimal postoperative/oncological outcomes. A recent study highlighted the difficulties of adopting TLPD into practice, due to the high number of anastomotic-related complications, resulting to a switch to HLPD instead.…”

“…In addition to the volume effect, the importance of the learning curve on outcomes in LPD has been reported. The minimum number of cases to overcome the initial learning curve has been reported to be around 20, but the minimum number of cases to achieve proficiency of TLPD is likely to be closer to 50–100 20–22 . Important aspects of the learning curve should incorporate not only a plateauing of operative times and improvement of safe surgical technique, but also achieving optimal postoperative/oncological outcomes.…”