Department of Medicine, Imperial College London, London, UK.
Department of Academic Surgery and Cancer, The Royal Marsden Hospital, 203 Fulham Rd, London, SW3 6JJ, UK.
Surg Endosc. 2023 Jun;37(6):4719-4727. doi: 10.1007/s00464-023-09941-8. Epub 2023 Mar 8.
An increasing number of robotic pancreatoduodenectomies (RPD) are reported, however, questions remain on the number of procedures needed for gaining technical proficiency in RPD. Therefore, we aimed to assess the influence of procedure volume on short-term RPD outcomes and assess the learning curve effect.
A retrospective review of consecutive RPD cases was undertaken. Non-adjusted cumulative sum (CUSUM) analysis was performed to identify the procedure volume threshold, following which before-threshold and after-threshold outcomes were compared.
Since May 2017, 60 patients had undergone an RPD at our institution. The median operative time was 360 min (IQR 302.25-442 min). CUSUM analysis of operative time identified 21 cases as proficiency threshold, indicated by curve inflexion. Median operative time was significantly shorter after the threshold of 21 cases (470 vs 320 min, p < 0.001). No significant difference was found between before- and after-threshold groups in major Clavien-Dindo complications (23.8 vs 25.6%, p = 0.876).
A decrease in operative time after 21 RPD cases suggests a threshold of technical proficiency potentially associated with an initial adjustment to new instrumentation, port placement and standardisation of operative step sequence. RPD can be safely performed by surgeons with prior laparoscopic surgery experience.
越来越多的机器人胰十二指肠切除术（RPD）被报道，然而，在获得 RPD 技术熟练程度所需的手术数量方面仍存在疑问。因此，我们旨在评估手术数量对 RPD 短期结果的影响，并评估学习曲线效应。
对连续的 RPD 病例进行回顾性研究。采用非调整累积和（CUSUM）分析来确定程序量的阈值，然后比较阈值前后的结果。
自 2017 年 5 月以来，我们医院有 60 名患者接受了 RPD。中位手术时间为 360 分钟（IQR 302.25-442 分钟）。CUSUM 分析手术时间确定了 21 例作为熟练阈值，表明曲线拐点。阈值后的中位手术时间明显缩短（470 与 320 分钟，p < 0.001）。在主要 Clavien-Dindo 并发症方面，阈值前后两组无显著差异（23.8%与 25.6%，p = 0.876）。
21 例 RPD 后手术时间的减少表明存在技术熟练程度的阈值，这可能与新仪器的初始调整、端口放置和手术步骤顺序的标准化有关。有腹腔镜手术经验的外科医生可以安全地进行 RPD。
