The Learning Curve in Robotic Pancreaticoduodenectomy

Abstract

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.

Minimally invasive versus open pancreatoduodenectomy—systematic review and meta-analysis

“…Previous studies have estimated that at least 50 cases for laparoscopic and 33 (up to 80 in one report) for robotic access are needed to achieve proficiency in performing them [24, 37–39]. However, in all of them, operative time was taken into consideration to establish the completion of the learning curve.…”

Systematic review and meta-analysis of robotic versus open pancreaticoduodenectomy

“…The operative time in RPD could be shortened with increased experience and technical advances. Apart from the learning curve, many other factors may affect the surgeons' performance in RPD such as the absence of tactile feedback, magnified vision and instrument collisions when traversing broader operative fields [25][26][27]. In addition, aberrant or anomalous hepatic arterial anatomy may add to the difficulty of an Table 4 Operative time, lymph nodes harvested and estimated blood loss of RPD versus OPD and conversion of RPD The means and standard deviations were imputed from medians and ranges which were reported in each study Surg Endosc already technically challenging RPD [28].…”

Robotic biotissue curriculum for teaching the robotic pancreatoduodenectomy

“…This left an opening for robotic . Robotic pancreatoduodenectomy (RPD) offers improved three-dimensional imaging, 540° movement of surgical instruments, improved dexterity, and precision in complex tasks like vascular dissection and intracorporeal suturing (15)(16)(17).However, wide-spread adoption of RPD is hindered by a significant learning curve (18)(19)(20) and the low volume of surgeries relative to the trainees. Tseng et al analyzed the learning curve of high volume pancreatic surgeons for open PD and found that perioperative morbidity and Abstract: Minimally invasive surgery has revolutionized the face of surgical practice.…”

“…However, wide-spread adoption of RPD is hindered by a significant learning curve (18)(19)(20) and the low volume of surgeries relative to the trainees. Tseng et al analyzed the learning curve of high volume pancreatic surgeons for open PD and found that perioperative morbidity and Abstract: Minimally invasive surgery has revolutionized the face of surgical practice.…”