Robotic assisted distal pancreatectomy: Learning curve

Abstract

IntroductionUse of minimally invasive surgery for distal pancreatectomy has been demonstrated with improvement in the length of hospitalisation, blood loss and splenic preservation rate. Current literature concerning operating time with robotic assistance is divergent. The aim of our study is to analyse the learning curve and the evolution of operating time in robotic assisted distal pancreatectomies. Patients and methodsFrom 2014 to 2021, in a single center performing 60 to 80 pancreatectomies per year, all patients who underwent robotic assisted distal pancreatectomy were included. A descriptive analysis of peri-operative data has been made as well as an analysis of the learning curve concerning operating time, intraoperative blood loss, splenic preservation rate, length of hospitalization, rate of pancreatic fistula, and grade III and IV Clavien-Dindo's complications. Results35 patients were included. The number of spleno-pancreatectomies and distal pancreatectomies with splenic preservation were, respectively 28 and 7. Mean operating time was 178 min. Rate of Grade III and IV Clavien Dindo's complications was 5.7%. There was no death within the 90 post operating days. During the inclusion period, the same surgeon performed 318 other robotic assisted digestive surgeries. The operating time was the criteria that improved the most. It decreased from a mean of 236 min for the first 8 procedures, to 165 min from the 9th intervention onwards. 5 out of 7 of splenic preservations were performed from the 26th procedure. Rate of blood loss, length of stay and post-operative complications did not improve during the study period. ConclusionOur analysis suggests a notable decrease in operating time from the 9th robotic assisted distal pancreatectomy and leans on the importance of global robotic expertise of the surgeon.