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. 2015 Jul;17(7):580-6.
doi: 10.1111/hpb.12412. Epub 2015 Apr 23.

The learning curve for robotic distal pancreatectomy: an analysis of outcomes of the first 100 consecutive cases at a high-volume pancreatic centre

Murtaza Shakir  1 , Brian A Boone  1 , Patricio M Polanco  1 , Mazen S Zenati  1 , Melissa E Hogg  1 , Allan Tsung  1 , Haroon A Choudry  1 , A James Moser  2 , David L Bartlett  1 , Herbert J Zeh  1 , Amer H Zureikat  1
Affiliations

The learning curve for robotic distal pancreatectomy: an analysis of outcomes of the first 100 consecutive cases at a high-volume pancreatic centre

Murtaza Shakir et al. HPB (Oxford). 2015 Jul.

Abstract

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.

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Figures

Figure 1
Figure 1
Operative times in 100 robotic distal pancreatectomies by consecutive groups of 10 patients per group
Figure 2
Figure 2
(a) CUSUM analysis of operative time showing three distinct phases of the learning curve for robotic distal pancreatectomy (RDP). CUSUMORT is plotted on the vertical axis against the respective case number. (b) Phase 1 indicates a rise in CUSUMORT with relative stabilization at case 20. (c) Phase 2 demonstrates a reduction in CUSUMORT after case 20. This is followed by a very slow increase in CUSUMORT with stabilization near case 40. (d) Phase 3 demonstrates a significant reduction in CUSUMORT after case 40
Figure 3
Figure 3
C-chart demonstrating decreasing variance from the mean operative time with increasing experience in robotic distal pancreatectomy
See this image and copyright information in PMC

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