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微创胰腺手术中的学习曲线:系统评价。

Learning curves in minimally invasive pancreatic surgery: a systematic review.

机构信息

Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

Medical School, University College London, London, UK.

出版信息

Langenbecks Arch Surg. 2022 Sep;407(6):2217-2232. doi: 10.1007/s00423-022-02470-3. Epub 2022 Mar 12.


DOI:10.1007/s00423-022-02470-3
PMID:35278112
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9467952/
Abstract

BACKGROUND: The learning curve of new surgical procedures has implications for the education, evaluation and subsequent adoption. There is currently no standardised surgical training for those willing to make their first attempts at minimally invasive pancreatic surgery. This study aims to ascertain the learning curve in minimally invasive pancreatic surgery. METHODS: A systematic search of PubMed, Embase and Web of Science was performed up to March 2021. Studies investigating the number of cases needed to achieve author-declared competency in minimally invasive pancreatic surgery were included. RESULTS: In total, 31 original studies fulfilled the inclusion criteria with 2682 patient outcomes being analysed. From these studies, the median learning curve for distal pancreatectomy was reported to have been achieved in 17 cases (10-30) and 23.5 cases (7-40) for laparoscopic and robotic approach respectively. The median learning curve for pancreaticoduodenectomy was reported to have been achieved at 30 cases (4-60) and 36.5 cases (20-80) for a laparoscopic and robotic approach respectively. Mean operative times and estimated blood loss improved in all four surgical procedural groups. Heterogeneity was demonstrated when factoring in the level of surgeon's experience and patient's demographic. CONCLUSIONS: There is currently no gold standard in the evaluation of a learning curve. As a result, derivations are difficult to utilise clinically. Existing literature can serve as a guide for current trainees. More work needs to be done to standardise learning curve assessment in a patient-centred manner.

摘要

背景:新手术程序的学习曲线对教育、评估和后续采用有影响。目前,对于那些愿意首次尝试微创胰腺手术的人,还没有标准化的手术培训。本研究旨在确定微创胰腺手术的学习曲线。

方法:对 PubMed、Embase 和 Web of Science 进行了系统检索,检索时间截至 2021 年 3 月。纳入了研究作者宣布在微创胰腺手术中达到胜任水平所需的病例数的研究。

结果:共有 31 项原始研究符合纳入标准,分析了 2682 例患者的结局。从这些研究中,腹腔镜和机器人辅助的远端胰腺切除术的中位学习曲线分别报告为 17 例(10-30 例)和 23.5 例(7-40 例),腹腔镜和机器人辅助的胰十二指肠切除术的中位学习曲线分别报告为 30 例(4-60 例)和 36.5 例(20-80 例)。所有四个手术组的手术时间和估计失血量均有改善。在考虑到外科医生经验水平和患者人口统计学因素时,存在异质性。

结论:目前,在评估学习曲线方面还没有金标准。因此,推导结果很难在临床上应用。现有文献可以作为当前学员的指南。需要做更多的工作来以患者为中心的方式标准化学习曲线评估。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f02/9467952/ecb788124bce/423_2022_2470_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f02/9467952/ec6064ec1dd2/423_2022_2470_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f02/9467952/ef4df52bdd1a/423_2022_2470_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f02/9467952/fd40218c00e4/423_2022_2470_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f02/9467952/ecb788124bce/423_2022_2470_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f02/9467952/ec6064ec1dd2/423_2022_2470_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f02/9467952/ef4df52bdd1a/423_2022_2470_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f02/9467952/fd40218c00e4/423_2022_2470_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f02/9467952/ecb788124bce/423_2022_2470_Fig4_HTML.jpg

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引用本文的文献

[1]
Institutional learning curve and factors of prolonged operation time of robotic distal pancreatectomy: An analysis of an initial 117 cases.

Ann Gastroenterol Surg. 2025-2-24

[2]
Laparoscopic management of intraductal oncocytic papillary neoplasm of the pancreas: Two case reports and review of literature.

World J Gastrointest Surg. 2025-4-27

[3]
Tampa difficulty score: a scoring system for difficulty of robotic pancreaticoduodenectomy.

J Robot Surg. 2024-12-16

[4]
Current landscape of minimally invasive pancreatectomy for neoplasms: A retrospective cohort study.

World J Surg. 2025-1

[5]
Effect of surgical approach on early return to intended oncologic therapy after resection for pancreatic ductal adenocarcinoma.

Surg Endosc. 2024-9

[6]
The current status of minimally invasive pancreatectomy and implications of the Brescia guidelines.

Gland Surg. 2024-4-29

[7]
Is the robotic approach the future of distal pancreatectomy with splenectomy? A propensity score matched analysis.

J Robot Surg. 2024-4-2

[8]
Defining the learning curve for robotic pancreaticoduodenectomy for a single surgeon following experience with laparoscopic pancreaticoduodenectomy.

J Robot Surg. 2024-3-16

[9]
Minimally Invasive Pancreaticoduodenectomy in Elderly versus Younger Patients: A Meta-Analysis.

Cancers (Basel). 2024-1-11

[10]
Minimally Invasive versus Open Distal Pancreatectomy in the 2020s: Recent Institutional Experience and a Narrative Review of Current Evidence.

J Clin Med. 2023-10-17

本文引用的文献

[1]
Outcomes of a Multicenter Training Program in Robotic Pancreatoduodenectomy (LAELAPS-3).

Ann Surg. 2022-12-1

[2]
Evaluation of a single surgeon's learning curve of laparoscopic pancreaticoduodenectomy: risk-adjusted cumulative summation analysis.

Surg Endosc. 2021-6

[3]
Total laparoscopic pancreaticoduodenectomy in patients with periampullary tumors: a learning curve analysis.

Surg Endosc. 2021-6

[4]
The learning curve for a surgeon in robot-assisted laparoscopic pancreaticoduodenectomy: a retrospective study in a high-volume pancreatic center.

Surg Endosc. 2018-11-27

[5]
Learning curves for robotic pancreatic surgery-from distal pancreatectomy to pancreaticoduodenectomy.

Medicine (Baltimore). 2018-11

[6]
Learning curve and surgical factors influencing the surgical outcomes during the initial experience with laparoscopic pancreaticoduodenectomy.

J Hepatobiliary Pancreat Sci. 2018-11-20

[7]
True learning curve of laparoscopic spleen-preserving distal pancreatectomy with splenic vessel preservation.

Surg Endosc. 2018-6-22

[8]
Analysis of learning curve for laparoscopic pancreaticoduodenectomy.

J Vis Surg. 2016-8-18

[9]
Preoperative risk factors for conversion and learning curve of minimally invasive distal pancreatectomy.

Surgery. 2017-11

[10]
Minimally invasive versus open pancreatoduodenectomy-systematic review and meta-analysis.

Langenbecks Arch Surg. 2017-8

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