ArticleSurgical endoscopy2025
Clinical efficacy and learning curve analysis of 101 robotic-assisted Warshaw procedures: a retrospective study.
Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Initial adaptation to robotic rectal cancer surgery using the hinotori surgical robot system: a CUSUM analysis of certified proctor surgeons.Journal of robotic surgery · 2026Article
- Fusion surgery in robot-assisted esophagectomy: stepwise learning curves across the da Vinci™ and hinotori™ platforms.World journal of surgical oncology · 2026Article
- Learning curve and perioperative outcomes of robotic-assisted distal pancreatectomy: a single-center study.Journal of robotic surgery · 2025Article
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6 authors.
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Abstract
objectiveTo evaluate the clinical efficacy of robotic-assisted Warshaw procedure and analyze its learning curve.
methodsThis retrospective case series analyzed 101 consecutive patients who underwent robotic-assisted Warshaw procedure at the Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Qingdao University, between November 2020 and January 2023. Patient demographics, perioperative outcomes, pathological findings, and follow-up data were collected. For continuous variables such as operative time and blood loss, the cumulative sum (CUSUM) method and best-fit curve analysis were employed to assess the learning curve. For categorical variables including major complications and textbook outcome, a 2-piece linear model was used. Patients were stratified into early learning phase and proficiency phase groups based on the identified inflection points, and perioperative outcomes were compared between groups.
results(1) Patient demographics and perioperative outcomes: Among 101 patients (21 males [20.79%] and 80 females [79.21%], mean age 48.90 ± 11.97 years), the mean operative time was 187.09 ± 52.36 min and median blood loss was 50 ml (IQR: 20-100 ml). The Warshaw procedure was successfully completed in 91 patients (90.10%), while 7 patients (6.93%) required conversion to distal pancreatectomy with splenectomy, and 3 patients (2.97%) were converted to open surgery. Postoperative pancreatic fistula (POPF) occurred in 18 patients (17.82%), including 13 biochemical leaks (12.87%) and 5 grade B fistulas (4.95%), with no grade C fistulas. No chylous fistula or delayed gastric emptying was observed. Postoperative hemorrhage occurred in 5 patients (4.95%) and intra-abdominal infection in 3 patients (2.97%), with 2 patients (1.98%) experiencing both complications requiring reoperation. One patient (0.99%) developed bowel obstruction. The mean time to first oral intake was 2.35 ± 0.69 days. Fifty-six patients (55.44%) were discharged with drains. Median postoperative hospital stay was 6.00 days (IQR: 5.00-7.50), and mean drainage duration was 9.88 ± 2.92 days. All patients were discharged without perioperative mortality or 90 day readmission. During follow-up, 10 patients (16.13%, 10/62) developed varying degrees of splenic infarction, and 13 patients (20.96%, 13/62) developed gastric varices, but no severe complications such as splenic abscess or gastrointestinal bleeding occurred. (2) Learning curve analysis: For operative time and blood loss, CUSUM learning curves were best fitted by the equations: CUSUM(operative time) = 0.003156X
conclusion(1) The robotic-assisted Warshaw procedure is safe and feasible. (2) Learning curve analysis revealed that proficiency in operative time and blood loss was achieved earlier, followed by postoperative complications (60 cases), while mastery of textbook outcomes required the most experience (85 cases).
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