The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
Surg Endosc. 2022 Jan;36(1):468-479. doi: 10.1007/s00464-021-08306-3. Epub 2021 Feb 3.
Distal pancreatectomy is the most common procedure in minimally-invasive pancreatic surgery. Data in the literature suggest that the learning curve flattens after performing up to 30 procedures. However, the exact number remains unclear.
The implementation and training with laparoscopic distal pancreatectomy (LDP) in a high-volume center were studied between 1997 and 2020. Perioperative outcomes and factors related to conversion were assessed. The individual experiences of four different surgeons (pioneer and adopters) performing LDP on a regular basis were examined.
Six hundred forty LDPs were done accounting for 95% of all distal pancreatectomies performed throughout the study period. Conversion was needed in 14 (2.2%) patients due to intraoperative bleeding or tumor adherence to the major vasculature. Overall morbidity and mortality rates were 35 and 0.6%, respectively. Intra- and postoperative outcomes did not change for any of the surgeons within their first 40 cases. Operative time significantly decreased after the first 80 cases for the pioneer surgeon and did not change afterwards although the proportion of ductal adenocarcinoma increased. Tumor size increased after the first 80 cases for the first adopter without affecting the operative time.
In this nearly unselected cohort, no significant changes in surgical outcomes were observed throughout the first 40 LDPs for different surgeons. The exact number of procedures required to overcome the learning curve is difficult to determine as it seems to depend on patient selection policy and specifics of surgical training at the corresponding center.
胰体尾切除术是微创胰腺手术中最常见的术式。文献中的数据表明，在完成 30 例左右的手术之后，学习曲线趋于平稳。但具体的例数仍不明确。
本研究在 1997 年至 2020 年间对一家高容量中心实施腹腔镜胰体尾切除术（LDP）的情况和培训进行了研究。评估了围手术期结果和与中转相关的因素。研究了四位常规进行 LDP 的不同外科医生（先驱者和接受者）的个人经验。
共完成了 644 例 LDP，占整个研究期间所有胰体尾切除术的 95%。由于术中出血或肿瘤与大血管粘连，有 14 例（2.2%）患者需要中转开腹。总的并发症发生率和死亡率分别为 35%和 0.6%。在他们的前 40 例手术中，没有任何一位外科医生的术中及术后结果发生变化。对于先驱者外科医生，手术时间在完成前 80 例后显著减少，尽管之后管状腺癌的比例增加，但之后没有变化。对于第一个接受者，肿瘤大小在完成前 80 例后增加，但手术时间没有变化。
在本几乎未选择的队列中，不同外科医生在完成前 40 例 LDP 期间，手术结果没有明显变化。克服学习曲线所需的手术例数很难确定，因为它似乎取决于患者选择政策和相应中心的手术培训特点。
