Hirata Yuki, Prakash Laura, Maxwell Jess, Snyder Rebecca, Kim Michael, Tran Cao Hop, Tzeng Ching-Wei D, Lee Jefferey E, Katz Matthew H G, Ikoma Naruhiko
Department of Surgery National Hospital Organization Tokyo Medical Center Tokyo Japan.
Department of Surgical Oncology The University of Texas MD Anderson Cancer Center Houston Texas USA.
Ann Gastroenterol Surg. 2025 Feb 24;9(4):861-869. doi: 10.1002/ags3.70005. eCollection 2025 Jul.
The granular methods by which centers can safely implement and effectively expand robotic distal pancreatectomy (RDP), including those related to appropriate patient selection during the learning curve period, remain unclear. This study aimed to verify that our strategic robotic surgical oncology program effectively implemented RDP as standard practice and to identify factors associated with prolonged operation time.
We performed a detailed analysis of the intraoperative and short-term outcomes of consecutive patients (October 2018-September 2023) undergoing RDP at our center, beginning with the first patient in our program. Operation time was analyzed using a cumulative sum chart (CUSUM), and factors associated with prolonged operation time were analyzed.
Throughout the study period, five surgeons performed RDP for 117 patients. The CUSUM analysis indicated our center required 18 cases to overcome the initial learning phase and 43 additional cases to become proficient. In contrast, when comparing short-term outcomes across the three observation periods, there were no significant changes in the incidence of ACCORDION grade ≥3 pancreatic fistulas ( = 0.684), or readmission rates ( = 0.457). A multivariable analysis revealed BMI ≥30 in male, the presence of pancreatitis or fibrosis, and the performance of concomitant procedures were associated with extended operation times, while BMI ≥30 in female was not.
Although an institutional learning curve was observed, our program enabled the safe implementation of RDP and successfully expanded the number of primary operating surgeons while maintaining stable short-term outcomes. The absence of an impact of high BMI on operation time in female patients suggests a notable advantage of robotic approach for these individuals.
各中心能够安全实施并有效扩大机器人辅助远端胰腺切除术（RDP）的具体方法，包括在学习曲线阶段进行适当患者选择的相关方法，仍不明确。本研究旨在验证我们的机器人手术肿瘤学战略计划是否有效地将RDP作为标准术式实施，并确定与手术时间延长相关的因素。
我们对2018年10月至2023年9月在本中心接受RDP的连续患者（从我们项目的首例患者开始）的术中及短期结果进行了详细分析。使用累积和图（CUSUM）分析手术时间，并分析与手术时间延长相关的因素。
在整个研究期间，5名外科医生为117例患者实施了RDP。CUSUM分析表明，我们中心需要18例病例来克服初始学习阶段，还需要43例病例才能达到熟练水平。相比之下，在比较三个观察期的短期结果时，≥3级胰瘘（=0.684）的发生率或再入院率（=0.457）没有显著变化。多变量分析显示，男性BMI≥30、存在胰腺炎或纤维化以及进行同期手术与手术时间延长相关，而女性BMI≥30则不然。
尽管观察到机构学习曲线，但我们的项目能够安全实施RDP，并成功增加了主刀外科医生的数量，同时保持了稳定的短期结果。高BMI对女性患者手术时间无影响，这表明机器人手术方法对这些患者具有显著优势。
