Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study

Chen, Shi; Chen, Jiang-Zhi; Zhan, Qimin; Deng, Xiaxing; Peng, Chenghong; Li, Hongwei

doi:10.1007/s00464-015-4140-y

Cited by 159 publications

(168 citation statements)

References 38 publications

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“…A reduction of 16 days in the median length of hospital stay after RAPD was reported when a surgeon moved from Italy to the US [8]. Interestingly, Chen et al [14] reported a mean length of stay exceeding 20 days, in agreement with our results.…”

Section: Discussionsupporting

confidence: 83%

“…The learning curve (LC) of RAPD was recently reported by 2 independent groups, both describing the concurrent LC of 2 surgeons [13,14]. We herein provide the first description of the LC of a single surgeon in RAPD.…”

Section: Introductionmentioning

confidence: 90%

“…Two groups recently described their LC in RAPD [13,14]. The Pittsburgh group analyzed 200 consecutive RAPD showing that OT dropped after 80 procedures and that further reduction was observed in the following cases.…”

Section: Discussionmentioning

confidence: 99%

“…In both the American [13] and the Chinese [14] experience, surgical proficiency in RAPD was simultaneously gained by 2 console surgeons. In particular, the dual surgeon approach was promoted and popularized by the Pittsburgh group, as they underscored that the challenges of RAPD were best faced by 2 attending surgeons, working in the context of a high volume center, with the support of a dedicated operative team [13].…”

Section: Discussionmentioning

confidence: 99%

“…These improvements corresponded to major changes in operative technique and may not exclusively reflect the effect of the LC [14]. …”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

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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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…These improvements corresponded to major changes in operative technique and may not exclusively reflect the effect of the LC [14]. …”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

The Learning Curve in Robotic Pancreaticoduodenectomy

Napoli¹,

Kauffmann²,

Palmeri³

et al. 2016

Dig Surg

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Short-term Outcomes After Robot-Assisted vs Open Pancreaticoduodenectomy After the Learning Curve

et al. 2020

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IMPORTANCE Robot-assisted pancreaticoduodenectomy (RPD) has been reported to be safe and feasible. As a new technique, RPD has a learning curve similar to that of other types of minimally invasive pancreatic surgery such as laparoscopic pancreaticoduodenectomy. To our knowledge, no reports exist on the outcomes of open pancreaticoduodenectomy (OPD) and RPD after the learning curve. OBJECTIVE To analyze and evaluate the actual advantages of RPD. DESIGN, SETTING, AND PARTICIPANTS Between May 2010 and December 2018, 450 patients underwent RPD in the Shanghai Ruijin Hospital affiliated with Shanghai Jiaotong University in Shanghai, China, a high-volume pancreatic disease center. According to our previous study, an important flexion point in the learning curve is 250 cases. Data on the last 200 RPD cases were collected from January 2017 to December 2018. During that period, 634 patients underwent OPD. These patients were divided into 2 groups, and propensity score matching was used to minimize bias. The demographic data and operative outcomes were collected and analyzed. Analysis began May 2019. EXPOSURES Robot-assisted pancreaticoduodenectomy and OPD. MAIN OUTCOMES AND MEASURES The short-term operative outcomes of RPD and OPD. RESULTS After 1:1 matching, 187 cases of RPD and OPD were recorded. In the RPD group, 78 patients (41.7%) were women, and the mean (SD) age was 60.9 (11.4) years. In the OPD group, 80 patients (42.8%) were women, and the mean (SD) age was 60.1 (10.8) years. Robot-assisted pancreaticoduodenectomy had advantages in operative time (mean [SD], 279.7 [76.3] minutes vs 298.2 [78.3] minutes; P = .02), estimated blood loss (mean [SD], 297.3 [246.8] mL vs 415.2 [497.9] mL; P = .002), and postoperative length of hospital stay (mean [SD], 22.4 [16.7] days vs 26.1 [16.3] days; P = .03). However, there was no significant difference in the R0 resection rate and incidence rate of postoperative complications, such as postoperative pancreatic fistula, bile leak, and delayed gastric emptying. The incidence rates of postoperative bleeding and reoperation in the RPD group were similar to those in the OPD group, with no statistically significant difference. CONCLUSIONS AND RELEVANCE After passing the learning curve, RPD had advantages in operative time and blood loss compared with OPD. There were no differences in postoperative complications such as postoperative pancreatic fistula, bile leak, and delayed gastric emptying. However, patients recovered more quickly after RPD than after OPD. A prospective randomized clinical trial is needed in the future to verify these results.

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Association of Mentorship and a Formal Robotic Proficiency Skills Curriculum With Subsequent Generations’ Learning Curve and Safety for Robotic Pancreaticoduodenectomy

et al. 2020

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IMPORTANCE Learning curves are unavoidable for practicing surgeons when adopting new technologies. However, patient outcomes are worse in the early stages of a learning curve vs after mastery. Therefore, it is critical to find a way to decrease these learning curves without compromising patient safety.OBJECTIVE To evaluate the association of mentorship and a formal proficiency-based skills curriculum with the learning curves of 3 generations of surgeons and to determine the association with increased patient safety. DESIGN, SETTING, AND PARTICIPANTS All consecutive robotic pancreaticoduodenectomies (RPDs) performed at the University of Pittsburgh Medical Center between 2008 and 2017 were included in this study. Surgeons were split into generations based on their access to mentorship and a proficiency-based skills curriculum. The generations are (1) no mentorship or curriculum, (2) mentorship but no curriculum, and (3) mentorship and curriculum. Univariable and multivariable analyses were used to create risk-adjusted learning curves by surgical generation and to analyze factors associated with operating room time, complications, and fellows completing the full resection. The participants include surgical oncology attending surgeons and fellows who participated in an RPD at University of Pittsburgh Medical Center between 2008 and 2017. MAIN OUTCOMES AND MEASURESThe primary outcome was operating room time (ORT). Secondary outcomes were postoperative pancreatic fistula and Clavien-Dindo classification higher than grade 2. RESULTSWe identified 514 RPDs completed between 2008 and 2017, of which 258 (50.2%) were completed by first-generation surgeons, 151 (29.3%) were completed by the second generation, and 82 (15.9%) were completed by the third generation. There was no statistically significant difference between groups with respect to age (66.3-67.3 years; P = .52) or female sex (n = 34 [41.5%] vs n = 121 [46.9%]; P = .60). There was a significant decrease in ORT (P < .001), from 450.8 minutes for the first-generation surgeons to 348.6 minutes for the third generation. Additionally, across generations, Clavien-Dindo classification higher than grade 2 (n = 74 [28.7%] vs n = 30 [9.9%] vs n = 12 [14.6%]; P = .01), conversion rates (n = 18 [7.0%] vs n = 7 [4.6%] vs n = 0; P = .006), and estimated blood loss (426 mL vs 288.6 mL vs 254.7 mL; P < .001) decreased significantly with subsequent generations. There were no significant differences in postoperative pancreatic fistula. CONCLUSIONS AND RELEVANCEIn this study, ORT, conversion rates, and estimated blood loss decreased across generations without a concomitant rise in adverse patient outcomes. These findings suggest that a proficiency-based curriculum coupled with mentorship allows for the safe introduction of less experienced surgeons to RPD without compromising patient safety.

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Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study

Abstract: This first largest, prospective matched study demonstrated that for treating selected borderline and malignant pathologies, RLPD was associated with a significant learning curve effect and expedited postoperative recovery, but had a surgical and oncological safety profile similar to OPD.

Cited by 159 publications

References 38 publications

The Learning Curve in Robotic Pancreaticoduodenectomy

The Learning Curve in Robotic Pancreaticoduodenectomy

Short-term Outcomes After Robot-Assisted vs Open Pancreaticoduodenectomy After the Learning Curve

Association of Mentorship and a Formal Robotic Proficiency Skills Curriculum With Subsequent Generations’ Learning Curve and Safety for Robotic Pancreaticoduodenectomy

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