Munseok Choi1,2,3, Ho Kyoung Hwang1,2,3, Woo Jung Lee1,2,3, Chang Moo Kang4,5,6. 1. Division of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, Korea. 2. Department of Surgery, Yonsei University College of Medicine, Ludlow Faculty Research Building #201, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea. 3. Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea. 4. Division of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, Korea. cmkang@yuhs.ac. 5. Department of Surgery, Yonsei University College of Medicine, Ludlow Faculty Research Building #201, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea. cmkang@yuhs.ac. 6. Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea. cmkang@yuhs.ac.
Abstract
BACKGROUND: With continued technical advances in surgical instruments and growing expertise, many surgeons have safely performed laparoscopic pylorus-preserving pancreaticoduodenectomies (LPDs) with good results, and the laparoscopic approach is being performed more frequently. However, this complex procedure requires a relatively long training period to ensure technical competence. The present study aimed to analyze the learning curve for LPD. METHODS: From September 2012 to May 2019, LPDs were performed for 171 patients at the Yonsei University Severance Hospital by a single surgeon. We retrospectively analyzed the demographic and surgical outcomes. The learning curve for LPD was evaluated using both the cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) methods. All 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 1-40), phase II represented the technical competence period (cases 41-100), and phase III was regarded as the challenging period (cases 101-171). CONCLUSIONS: According to the learning curve analysis, 40 cases are required to achieve technical competence in LPD and 100 cases are required to address highly challenging cases.
BACKGROUND: With continued technical advances in surgical instruments and growing expertise, many surgeons have safely performed laparoscopic pylorus-preserving pancreaticoduodenectomies (LPDs) with good results, and the laparoscopic approach is being performed more frequently. However, this complex procedure requires a relatively long training period to ensure technical competence. The present study aimed to analyze the learning curve for LPD. METHODS: From September 2012 to May 2019, LPDs were performed for 171 patients at the Yonsei University Severance Hospital by a single surgeon. We retrospectively analyzed the demographic and surgical outcomes. The learning curve for LPD was evaluated using both the cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) methods. All 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 1-40), phase II represented the technical competence period (cases 41-100), and phase III was regarded as the challenging period (cases 101-171). CONCLUSIONS: According to the learning curve analysis, 40 cases are required to achieve technical competence in LPD and 100 cases are required to address highly challenging cases.
Authors: Tran Manh Hung; Tran Que Son; Tran Hieu Hoc; Tran Thanh Tung; Trieu Van Truong; Le Manh Cuong; Vu Duy Kien Journal: Ann Med Surg (Lond) Date: 2021-08-10