ArticleSurgical endoscopy2026
Learning curve of robotic pancreaticoduodenectomy: a CUSUM and risk-adjusted CUSUM analysis of 120 consecutive cases.
Article in Surgical endoscopy, 2026. 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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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
17 authors.
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Abstract
backgroundRobotic pancreaticoduodenectomy (RPD) has progressively gained acceptance in high-volume pancreatic surgery centers. However, the learning curve associated with implementation of an RPD program remains incompletely defined. This study aimed to evaluate the learning curve of RPD using cumulative sum (CUSUM) and risk-adjusted cumulative sum (RA-CUSUM) analyses.
methodsA retrospective analysis of a prospectively maintained database including 120 consecutive patients undergoing RPD between January 2023 and April 2026 was performed. CUSUM analysis of operative time and RA-CUSUM analysis of major postoperative morbidity (Clavien-Dindo grade ≥III) were used to assess operative efficiency and postoperative safety, respectively. Outcomes were compared before and after the exploratory RA-CUSUM-derived learning curve transition point.
resultsMedian operative time was 625 min (IQR 568-706), whereas major postoperative morbidity occurred in 30 patients (25%). CUSUM analysis identified an inflection point at case 49, demonstrating progressive improvement in operative efficiency. Linear regression analysis confirmed a significant reduction in operative time across consecutive procedures (regression coefficient - 1.68 min/case; R
conclusionsRPD demonstrates a measurable learning curve characterized by progressive improvement in operative efficiency and postoperative safety. These findings suggest that postoperative safety may provide a more clinically meaningful framework than operative time alone for describing the evolution of the learning curve.
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