Abstract
No data are available on the learning curve in robotic distal pancreatectomy (RADP). The learning curve in RADP was assessed in 55 consecutive patients using the cumulative sum method, based on operative time. Data were extracted from a prospectively maintained database and analyzed retrospectively considering all events occurring within 90 days of surgery. No operation was converted to laparoscopic or open surgery and no patient died. Post-operative complications occurred in 34 patients (61.8 %), being of Clavien–Dindo grade I–II in 32 patients (58.1 %), including pancreatic fistula in 29 patients (52.7 %). No grade C pancreatic fistula occurred. Four patients received blood transfusions (7.2 %), three were readmitted (5.4 %) and one required repeat surgery (1.8 %). Based on the reduction of operative times (421.1 ± 20.5 vs 248.9 ± 9.3 min; p < 0.0001), completion of the learning curve was achieved after ten operations. Operative time of the first 10 operations was associated with a positive slope (0.47 + 1.78* case number; R 2 0.97; p < 0.0001*), while that of the following 45 procedures showed a negative slope (23.52 − 0.39* case number; R 2 0.97; p < 0.0001*). After completion of the learning curve, more patients had a malignant histology (0 vs 35.6 %; p = 0.002), accounting for both higher lymph node yields (11.1 ± 12.2 vs 20.9 ± 18.5) (p = 0.04) and lower rate of spleen preservation (90 vs 55.6 %) (p = 0.04). RADP was safely feasible in selected patients and the learning curve was completed after ten operations. Improvement in clinical outcome was not demonstrated, probably because of the limited occurrence of outcome comparators.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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This article does not contain any studies with human participants or animals performed by any of the authors.
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Patients were extensively counseled about their disease, the operation that was planned, and the use of robotic assistance. All patients signed an informed consent.
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Napoli, N., Kauffmann, E.F., Perrone, V. et al. The learning curve in robotic distal pancreatectomy. Updates Surg 67, 257–264 (2015). https://doi.org/10.1007/s13304-015-0299-y
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DOI: https://doi.org/10.1007/s13304-015-0299-y