Learning curve for robotic pancreaticoduodenectomy with modified blumgart reconstruction

Abstract

Objective: Pancreaticoduodenectomy has been a technically demanding and challenging procedure carrying a high morbidity.This study was to identify the learning curve of console time (CT) for robotic pancreatectomy (RPD). Perioperative outcomes were compared between early group before the learning curve and late group after the learning curve. Methods: Data for RPD were prospectively collected for analysis. The learning curve was assessed by cumulative sum (CUSUM). Based on CUSUM analyses, patients were was divided into early group before learning curve and late group after learning curve. Results: There were 70 RDP and 100 RPD cases. It took 37 cases to overcome the learning curve for RDP and 20 cases for RPD. The median console time was also significantly shorter in the late group for both RDP (112 min. vs. 225 min., P < 0.001) and RPD (360 min. vs. 520 min., P < 0.001). The median blood loss was significantly less in the late group for both RDP (30 c.c. vs. 100 c.c., P = 0.003) and RPD (100 c.c. vs. 200 c.c., P < 0.001). No surgical mortality in both groups. Clinical relevant pancreatic fistula was 22.9% for RDP (32.4% in early group vs. 12.1% in late group, P = 0.043), and 11.5% for RPD (0 in early group vs. 17.1% in late group, P = 0.084). Conclusions: Robotic surgery is feasible both RDP and RPD. Moreover, earlier experience in RDP might shorten the learning curve for RPD.