Yuichi Nagakawa1, Yoshiharu Nakamura2, Goro Honda3, Yoshitaka Gotoh4, Takao Ohtsuka4, Daisuke Ban5, Kohei Nakata4, Yatsuka Sahara1, Vittoria Vanessa D M Velasquez4, Kyoichi Takaori6, Takeyuki Misawa7, Tamotsu Kuroki8, Manabu Kawai9, Takanori Morikawa10, Hiroki Yamaue9, Minoru Tanabe5, Yiping Mou11, Woo-Jung Lee12, Shailesh V Shrikhande13, Claudius Conrad14, Ho-Seong Han15, Chung Ngai Tang16, Chinnusamy Palanivelu17, David A Kooby18, Horacio J Asbun19, Go Wakabayashi20, Akihiko Tsuchida1, Tadahiro Takada21, Masakazu Yamamoto22, Masafumi Nakamura4. 1. Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan. 2. Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan. 3. Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. 4. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 5. Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan. 6. Division of Hepatobiliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Kyoto, Japan. 7. Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan. 8. Department of Surgery, National Hospital Nagasaki Medical Center, Nagasaki, Japan. 9. Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan. 10. Department of Surgery, Tohoku University, Sendai, Japan. 11. Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China. 12. Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, South Korea. 13. Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Mumbai, India. 14. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 15. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea. 16. Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China. 17. Division of Gastrointestinal Surgery and Minimal Access Surgery, GEM Hospital and Research Centre, Coimbatore, India. 18. Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. 19. Department of General Surgery, Mayo Clinic, xxx, FL, USA. 20. Department of Surgery, Ageo Central General Hospital, Ageo, Japan. 21. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan. 22. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
Abstract
BACKGROUND: Laparoscopic pancreaticoduodenectomy (LPD) requires sufficient laparoscopic training for optimal outcomes. Our aim is to determine the learning curve and investigate the factors influencing surgical outcomes during the learning curve. METHODS: We analyzed surgical results of 150 consecutive cases of LPD performed by three hepatopancreatobiliary surgeons during their 50 first cases. Learning curves were constructed by cumulative sum (CUSUM) analysis. Preoperative factors influencing resection time and blood loss were investigated in the introductory and stable periods. RESULTS : The learning curve could be divided into three phases: initial (1-20 cases), plateau (21-30), and stable (31-50). Resection time with lymph node dissection was significantly longer during the introductory period (initial and plateau periods) (P < 0.01) but not the stable phase (P = 0.51). Multivariate analysis revealed that patients with pancreatitis had longer resection times and massive blood loss in both the introductory and stable periods (stable phase). High visceral fat area was also significantly related to massive blood loss in the introductory period (P = 0.04). CONCLUSIONS: Hepatopancreatobiliary surgeons need more than 30 cases until LPD becomes stable. Lymph node dissection and patients with high visceral fat area and concomitant pancreatitis should be avoided during the introductory period of the learning curve.
BACKGROUND: Laparoscopic pancreaticoduodenectomy (LPD) requires sufficient laparoscopic training for optimal outcomes. Our aim is to determine the learning curve and investigate the factors influencing surgical outcomes during the learning curve. METHODS: We analyzed surgical results of 150 consecutive cases of LPD performed by three hepatopancreatobiliary surgeons during their 50 first cases. Learning curves were constructed by cumulative sum (CUSUM) analysis. Preoperative factors influencing resection time and blood loss were investigated in the introductory and stable periods. RESULTS : The learning curve could be divided into three phases: initial (1-20 cases), plateau (21-30), and stable (31-50). Resection time with lymph node dissection was significantly longer during the introductory period (initial and plateau periods) (P < 0.01) but not the stable phase (P = 0.51). Multivariate analysis revealed that patients with pancreatitis had longer resection times and massive blood loss in both the introductory and stable periods (stable phase). High visceral fat area was also significantly related to massive blood loss in the introductory period (P = 0.04). CONCLUSIONS: Hepatopancreatobiliary surgeons need more than 30 cases until LPD becomes stable. Lymph node dissection and patients with high visceral fat area and concomitant pancreatitis should be avoided during the introductory period of the learning curve.
Authors: Michele Mazzola; Alessandro Giani; Jacopo Crippa; Lorenzo Morini; Andrea Zironda; Camillo Leonardo Bertoglio; Paolo De Martini; Carmelo Magistro; Giovanni Ferrari Journal: Indian J Surg Oncol Date: 2021-08-16
Authors: Heidy Cos; Michael T LeCompte; Sanket Srinivasa; Jorge Zarate Rodriguez; Cheryl A Woolsey; Gregory Williams; Siddarth Patel; Adeel Khan; Ryan C Fields; Maria B Majella Doyle; William C Chapman; Steven M Strasberg; William G Hawkins; Chet W Hammill; Dominic E Sanford Journal: Surg Endosc Date: 2021-07-07 Impact factor: 3.453