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Competency, Proficiency, and Mastery: Learning Curves for Robotic Distal Pancreatectomy at 16 International Expert
Philip C Müller1, Christoph Kuemmerli1, Adrian T Billeter1
1Department of Surgery, Clarunis University Digestive Health Care Center, University Hospital Basel, Basel, Switzerland.
Annals of Surgery
|November 19, 2024
Summary
Robotic distal pancreatectomy (RDP) learning curves show competency after 46 procedures, proficiency after 63, and mastery after 73. Extensive experience is crucial for mastering this minimally invasive approach.
Area of Science:
- Minimally Invasive Surgery
- Surgical Education
- Robotic Surgery
Background:
- Robotic distal pancreatectomy (RDP) is an emerging minimally invasive surgical technique.
- Limited multi-center data exists on RDP implementation and its learning curve.
Purpose of the Study:
- To evaluate the learning curve phases for robotic distal pancreatectomy (RDP) across international expert centers.
- To establish benchmarks for competency, proficiency, and mastery in RDP.
Main Methods:
- Analysis of 1109 consecutive RDP procedures from 16 international expert centers.
- Defined learning curve cutoffs based on operative time (competency), major complications (proficiency), and textbook outcome (mastery).
- Compared clinical outcomes before and after established learning curve milestones.
Main Results:
- Competency, proficiency, and mastery were achieved at 46, 63, and 73 RDP procedures, respectively.
- Significant reductions in operative time and major complications were observed post-competency and post-proficiency.
- Mastery correlated with a higher rate of textbook outcomes; postoperative pancreatic fistula rates remained stable.
Conclusions:
- International expert centers demonstrate that RDP learning curves are completed relatively early for intraoperative parameters.
- Achieving mastery in RDP requires extensive surgical experience beyond initial competency and proficiency.
- The study provides valuable benchmarks for RDP training and quality assessment.
