ArticleLangenbeck's archives of surgery2025
From open to robotic distal pancreatectomy: the learning curve and mastering benchmark outcomes in a Scandinavian high volume center.
Article in Langenbeck's archives of surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundRobotic distal pancreatectomy is increasingly utilized for the treatment of both benign and malignant lesions in the body and tail of pancreas. The aim of the current study was to report outcomes of the implementation of robotic distal pancreatectomy in a high-volume center with special emphasis on the learning curve.
methodsThis was a retrospective single-center study of consecutive patients undergoing robotic distal pancreatectomy performed by a dedicated team of three surgeons at a high-volume HPB center from September 2019 to November 2023. Patients with borderline or locally advanced tumors, or ingrowth in neighboring organs were not included for robotic approach. Intra- and postoperative outcomes were registered and compared across three pre-defined time periods of the first 40, middle 40 and remaining 40 procedures. Cumulative sum analysis was performed for the outcomes duration of surgery and textbook outcome.
resultsA total of 120 consecutive patients were included. The mean duration of surgery decreased significantly from 264 min to 239 min and lastly 222 min per procedure (P = 0.003) and the learning curve for this outcome was reached after 70 cases. The rate of splenic preservation was highest in the last period (12.5% vs. 12.5% vs. 30.0%, P = 0.066). The rate of textbook outcome across the three time periods increased (62.5% vs. 70.0% vs. 82.5%) and most benchmark values were obtained in the third period. The learning curve effect reached benchmark outcome values after 60 procedures and achieved better than expected outcomes after 90 procedures.
conclusionsRobotic distal pancreatectomy was safely implemented in a high volume HPB-center going from open to robotic approach. The learning curve was surpassed after 19 procedures reaching benchmark outcome values after 60 procedures.
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