Outcome of robot-assisted pancreaticoduodenectomy during initial learning curve versus laparotomy

Abstract

To analyze the initial learning curve (LC) for robot-assisted pancreaticoduodenectomy (RAPD) and compare RAPD during the initial LC with open pancreaticoduodenectomy (OPD) in terms of outcome. This study is a retrospective review of patients who consecutively underwent RAPD and OPD between October 2015 and January 2020 in our hospital. 41 consecutive RAPD cases and 53 consecutive open cases were enrolled for review. Compared with OPD, RAPD required a significantly longer operative time (401.1 ± 127.5 vs. 230.8 ± 44.5 min, P < 0.001) and higher cost (194621 ± 78342 vs. 121874 ± 39973 CNY, P < 0.001). Moreover, compared with the OPD group, the RAPD group revealed a significantly smaller mean number of lymph nodes harvested in malignant cases (15.6 ± 5.9 vs 18.9 ± 7.3, P = 0.025). No statistically significant differences were observed between the two groups in terms of incidence of Clavien-Dindo grade III-V morbidities and 90-day mortality and readmission (P>0.05). In the CUSUM graph, one peak point was observed at the 8th case, after which the operation time began to decrease. LC for RAPD may be less than 30 cases, and RAPD is safe and feasible during the initial LC.

Figure 1

Placement of the 5 ports. RA1: 8-mm trocar along the left anterior axillary line; RA2: 8-mm trocar along the right midclavear line; RA3: 8-mm trocar along the right anterior axillary line; The optic port (OP):12-mm trocar under umbilicus; The assistant port (AP):12-mm trocar along the left midclavear line. UAM: Upper abdomen midline incision.

Figure 2

Graph of operative times plotted for each of the 41 consecutive patients.

Figure 3

Cumulative sum graph for operative time.