BACKGROUND: Robotic distal pancreatectomy (RDP) is performed increasingly, but knowledge of the number of cases required to attain procedural proficiency is lacking. The aim of this study was to identify the learning curve associated with RDP at a high-volume pancreatic centre. METHODS: Metrics of perioperative safety and efficiency for all consecutive RDPs were evaluated. Outcomes were followed to 90 days. Cumulative sum (CUSUM) analysis was used to identify inflexion points corresponding to the learning curve. RESULTS: Between 2008 and 2013, 100 patients underwent RDP. There was no 90-day mortality. In two patients (2.0%), surgery was converted to laparotomy. Thirty procedures were performed for pancreatic adenocarcinoma. Precipitous operative time reductions from an initial operative time of 331 min were observed after the first 20 and 40 cases to 266 min and 210 min, respectively (P < 0.0001). The likelihood of readmission was significantly lower after the first 40 cases (P = 0.04), and non-significant reductions were observed in incidences of major (Clavien-Dindo Grade II or higher) morbidity and Grade B and C leaks, and length of stay. CONCLUSIONS: In this experience, RDP outcomes were optimized after 40 cases. Familiarity with the platform and dedicated training are likely to contribute to significantly shorter learning curves in future adopters.
BACKGROUND: Robotic distal pancreatectomy (RDP) is performed increasingly, but knowledge of the number of cases required to attain procedural proficiency is lacking. The aim of this study was to identify the learning curve associated with RDP at a high-volume pancreatic centre. METHODS: Metrics of perioperative safety and efficiency for all consecutive RDPs were evaluated. Outcomes were followed to 90 days. Cumulative sum (CUSUM) analysis was used to identify inflexion points corresponding to the learning curve. RESULTS: Between 2008 and 2013, 100 patients underwent RDP. There was no 90-day mortality. In two patients (2.0%), surgery was converted to laparotomy. Thirty procedures were performed for pancreatic adenocarcinoma. Precipitous operative time reductions from an initial operative time of 331 min were observed after the first 20 and 40 cases to 266 min and 210 min, respectively (P < 0.0001). The likelihood of readmission was significantly lower after the first 40 cases (P = 0.04), and non-significant reductions were observed in incidences of major (Clavien-Dindo Grade II or higher) morbidity and Grade B and C leaks, and length of stay. CONCLUSIONS: In this experience, RDP outcomes were optimized after 40 cases. Familiarity with the platform and dedicated training are likely to contribute to significantly shorter learning curves in future adopters.
Authors: Daniel Borja-Cacho; Waddah B Al-Refaie; Selwyn M Vickers; Todd M Tuttle; Eric H Jensen Journal: J Am Coll Surg Date: 2009-10-08 Impact factor: 6.113
Authors: George Melich; Young Ki Hong; Jieun Kim; Hyuk Hur; Seung Hyuk Baik; Nam Kyu Kim; A Sender Liberman; Byung Soh Min Journal: Surg Endosc Date: 2014-07-17 Impact factor: 4.584
Authors: David A Kooby; William G Hawkins; C Max Schmidt; Sharon M Weber; David J Bentrem; Theresa W Gillespie; Johnita Byrd Sellers; Nipun B Merchant; Charles R Scoggins; Robert C G Martin; Hong Jin Kim; Syed Ahmad; Clifford S Cho; Alexander A Parikh; Carrie K Chu; Nicholas A Hamilton; Courtney J Doyle; Scott Pinchot; Amanda Hayman; Rebecca McClaine; Attila Nakeeb; Charles A Staley; Kelly M McMasters; Keith D Lillemoe Journal: J Am Coll Surg Date: 2010-05 Impact factor: 6.113
Authors: Deepa Magge; William Gooding; Haroon Choudry; Jennifer Steve; Jennifer Steel; Amer Zureikat; Alyssa Krasinskas; Mustapha Daouadi; Kenneth K W Lee; Steven J Hughes; Herbert J Zeh; A James Moser Journal: JAMA Surg Date: 2013-06 Impact factor: 14.766
Authors: Mustapha Daouadi; Amer H Zureikat; Mazen S Zenati; Haroon Choudry; Alan Tsung; David L Bartlett; Steven J Hughes; Ken K Lee; A James Moser; Herbert J Zeh Journal: Ann Surg Date: 2013-01 Impact factor: 12.969
Authors: Yinin Hu; Joshua S Jolissaint; Adriana Ramirez; Ryan Gordon; Zequan Yang; Robert G Sawyer Journal: J Surg Res Date: 2014-05-23 Impact factor: 2.192
Authors: Daniel P Nussbaum; Kara Penne; Paul J Speicher; Sandra S Stinnett; Alexander Perez; Rebekah R White; Bryan M Clary; Douglas S Tyler; Dan G Blazer Journal: J Surg Res Date: 2014-02-24 Impact factor: 2.192
Authors: Deepthi M Reddy; Courtney M Townsend; Yong-Fang Kuo; Jean L Freeman; James S Goodwin; Taylor S Riall Journal: J Gastrointest Surg Date: 2009-09-16 Impact factor: 3.452
Authors: Thijs de Rooij; Sjors Klompmaker; Mohammad Abu Hilal; Michael L Kendrick; Olivier R Busch; Marc G Besselink Journal: Nat Rev Gastroenterol Hepatol Date: 2016-02-17 Impact factor: 46.802
Authors: Horacio J Asbun; Jony Van Hilst; Levan Tsamalaidze; Yoshikuni Kawaguchi; Dominic Sanford; Lucio Pereira; Marc G Besselink; John A Stauffer Journal: Surg Endosc Date: 2019-05-28 Impact factor: 4.584
Authors: Luise I M Pernar; Faith C Robertson; Ali Tavakkoli; Eric G Sheu; David C Brooks; Douglas S Smink Journal: Surg Endosc Date: 2017-04-14 Impact factor: 4.584
Authors: Ahmad Hamad; Mazen S Zenati; Trang K Nguyen; Melissa E Hogg; Herbert J Zeh; Amer H Zureikat Journal: Surg Endosc Date: 2017-12-22 Impact factor: 4.584
Authors: Michael H Gerber; Daniel Delitto; Cristina J Crippen; Thomas J George; Kevin E Behrns; Jose G Trevino; Jessica L Cioffi; Steven J Hughes Journal: J Gastrointest Surg Date: 2017-05-31 Impact factor: 3.452
Authors: Camille L Stewart; Philip H G Ituarte; Kurt A Melstrom; Susanne G Warner; Laleh G Melstrom; Lily L Lai; Yuman Fong; Yanghee Woo Journal: Surg Endosc Date: 2018-10-24 Impact factor: 4.584