Mingjun Wang1, Lingwei Meng1, Yunqiang Cai1, Yongbin Li1, Xin Wang1, Zhaoda Zhang2, Bing Peng3. 1. Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, China. 2. Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, China. wmjjmw01zzd@126.com. 3. Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, China. wmjjmw01pb@126.com.
Abstract
BACKGROUND: Laparoscopic pancreaticoduodenectomy (LPD), an advanced minimally invasive technique, has demonstrated advantages to open pancreaticoduodenectomy (OPD). However, this complex procedure requires a relatively long training period to ensure technical proficiency. This study was therefore designed to analyze the learning curve for LPD. METHODS: From October 2010 to September 2015, 63 standard pancreaticoduodenectomy procedures were to be performed laparoscopically by a single surgeon at the Department of Pancreatic Surgery, West China Hospital, Sichuan University, China. After applying the inclusion and exclusion criteria, a total of 57 patients were included in the study. Data for all the patients, including preoperative, intraoperative, and postoperative variables, were prospectively collected and analyzed. The learning curve for LPD was evaluated using both cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) methods. All of the variables among the learning curve phases were compared. RESULTS: Based on the CUSUM and the RA-CUSUM analyses, the learning curve for LPD was grouped into three phases: phase I was the initial learning period (cases 1-11), phase II represented the technical competence period (cases 12-38), and phase III was regarded as the challenging period (cases 39-57). The operative time, intraoperative blood loss, and postoperative ICU demand significantly decreased with the learning curve. More lymph nodes were collected after the initial learning period. There were no significant differences in terms of postoperative complications or the 30-day mortality among the three phases. More challenging cases were encountered in phase III. CONCLUSIONS: According to this study, the learning curve for LPD consisted of three phases. Conservatively, to attain technical competence for performing LPD, a minimum of 40 cases are required for laparoscopic surgeons with a degree of laparoscopic experience.
BACKGROUND: Laparoscopic pancreaticoduodenectomy (LPD), an advanced minimally invasive technique, has demonstrated advantages to open pancreaticoduodenectomy (OPD). However, this complex procedure requires a relatively long training period to ensure technical proficiency. This study was therefore designed to analyze the learning curve for LPD. METHODS: From October 2010 to September 2015, 63 standard pancreaticoduodenectomy procedures were to be performed laparoscopically by a single surgeon at the Department of Pancreatic Surgery, West China Hospital, Sichuan University, China. After applying the inclusion and exclusion criteria, a total of 57 patients were included in the study. Data for all the patients, including preoperative, intraoperative, and postoperative variables, were prospectively collected and analyzed. The learning curve for LPD was evaluated using both cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) methods. All of the variables among the learning curve phases were compared. RESULTS: Based on the CUSUM and the RA-CUSUM analyses, the learning curve for LPD was grouped into three phases: phase I was the initial learning period (cases 1-11), phase II represented the technical competence period (cases 12-38), and phase III was regarded as the challenging period (cases 39-57). The operative time, intraoperative blood loss, and postoperative ICU demand significantly decreased with the learning curve. More lymph nodes were collected after the initial learning period. There were no significant differences in terms of postoperative complications or the 30-day mortality among the three phases. More challenging cases were encountered in phase III. CONCLUSIONS: According to this study, the learning curve for LPD consisted of three phases. Conservatively, to attain technical competence for performing LPD, a minimum of 40 cases are required for laparoscopic surgeons with a degree of laparoscopic experience.
Authors: Paul J Speicher; Daniel P Nussbaum; Rebekah R White; Sabino Zani; Paul J Mosca; Dan G Blazer; Bryan M Clary; Theodore N Pappas; Douglas S Tyler; Alexander Perez Journal: Ann Surg Oncol Date: 2014-06-13 Impact factor: 5.344
Authors: Kristopher P Croome; Michael B Farnell; Florencia G Que; K Marie Reid-Lombardo; Mark J Truty; David M Nagorney; Michael L Kendrick Journal: Ann Surg Date: 2014-10 Impact factor: 12.969
Authors: Thierry Bege; Bernard Lelong; Benjamin Esterni; Olivier Turrini; Jerôme Guiramand; Daniel Francon; Djamel Mokart; Gilles Houvenaeghel; Marc Giovannini; Jean Robert Delpero Journal: Ann Surg Date: 2010-02 Impact factor: 12.969
Authors: Linda M Pak; Mithat Gonen; Kenneth Seier; Vinod P Balachandran; Michael I D'Angelica; William R Jarnagin; T Peter Kingham; Peter J Allen; Richard K G Do; Amber L Simpson Journal: Abdom Radiol (NY) Date: 2018-08
Authors: M Thomaschewski; H Neeff; T Keck; H P H Neumann; T Strate; E von Dobschuetz Journal: Rev Endocr Metab Disord Date: 2017-12 Impact factor: 6.514
Authors: Vejay N Vakharia; Roman Rodionov; Andrew W McEvoy; Anna Miserocchi; Rachel Sparks; Aidan G O'Keeffe; Sebastien Ourselin; John S Duncan Journal: J Neurosurg Date: 2018-02-16 Impact factor: 5.115
Authors: Andrew A Gumbs; Elie Chouillard; Mohamed Abu Hilal; Roland Croner; Brice Gayet; Michel Gagner Journal: Surg Endosc Date: 2020-11-04 Impact factor: 4.584