Learning Curves in Establishing a New Minimally Invasive Pancreas Program

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Robotic Surgery

Background:

• Robotic pancreaticoduodenectomy (rPD) is a complex procedure with a significant learning curve.
• A new rPD program was initiated by fellowship-trained surgeons with no prior institutional experience.
• The program aimed to establish a new minimally invasive pancreas program.

Purpose of the Study:

• To evaluate the learning curve for establishing a new robotic pancreaticoduodenectomy (rPD) program.
• To assess the feasibility of implementing rPD by fellowship-trained surgeons.
• To compare outcomes against established proficiency benchmarks.

Main Methods:

• A retrospective review of 60 patients undergoing rPD between 2016 and 2022.
• Comparison of institutional outcomes with proficiency benchmarks from the University of Pittsburg.
• Analysis of operative time, postoperative pancreatic fistula, mortality, complications, and length of stay.

Main Results:

• Operative time reached the proficiency benchmark of 391 minutes by 30 cases.
• The cohort demonstrated comparable rates of postoperative pancreatic fistula (6.7% vs 3%), 30-day mortality (0% vs 3%), and major complications (23% vs 17%) to benchmarks.
• Length of stay was similar to benchmarks (6 vs 7 days).

Conclusions:

• Perioperative outcomes were comparable to proficiency benchmarks from the program's initiation.
• Graduates of formal rPD training programs can safely establish new minimally invasive pancreas programs.
• Formal training facilitates the rapid development of institutional rPD expertise.