The learning curve in robotic distal pancreatectomy

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Robotic distal pancreatectomy (RADP) is an emerging technique with limited data on its learning curve.
• Assessing the learning curve is crucial for establishing proficiency and optimizing patient outcomes in complex procedures.

Purpose of the Study:

• To evaluate the learning curve associated with robotic distal pancreatectomy (RADP).
• To determine the number of cases required to achieve proficiency in RADP.
• To analyze changes in operative time and surgical outcomes during the learning phase.

Main Methods:

• Retrospective analysis of 55 consecutive patients undergoing RADP.
• Utilized the cumulative sum (CUSUM) method based on operative time to assess the learning curve.
• Collected data on operative details, post-operative complications (Clavien-Dindo classification), and pathological findings.

Main Results:

• The learning curve for RADP was completed after ten operations, indicated by a significant reduction in operative time (421.1 ± 20.5 min to 248.9 ± 9.3 min).
• Post-operative complications occurred in 61.8% of patients, primarily Clavien-Dindo grade I-II (58.1%), with a 52.7% rate of pancreatic fistula (no grade C).
• After completing the learning curve, a higher proportion of patients had malignant histology (35.6% vs 0%), with increased lymph node yield and decreased spleen preservation rates.

Conclusions:

• Robotic distal pancreatectomy (RADP) is safely feasible in selected patients, with proficiency achieved after approximately ten cases.
• While operative efficiency improves, significant enhancements in clinical outcomes were not demonstrated, potentially due to the limited number of outcome events.
• Further research with larger cohorts is warranted to fully elucidate the impact of RADP on long-term patient outcomes.