Evaluating the learning curve of robotic radical antegrade modular pancreatosplenectomy: A retrospective cohort study

Mengyang Li; Qu Liu; Tao Zhang; Yuanxing Gao; Xianglong Tan; Zhuzeng Yin; Zhiming Zhao; Rong Liu

doi:10.1016/j.ijsu.2022.106612

Evaluating the learning curve of robotic radical antegrade modular pancreatosplenectomy: A retrospective cohort study

Int J Surg. 2022 May:101:106612. doi: 10.1016/j.ijsu.2022.106612. Epub 2022 Apr 18.

Authors

Mengyang Li¹, Qu Liu², Tao Zhang³, Yuanxing Gao¹, Xianglong Tan¹, Zhuzeng Yin¹, Zhiming Zhao⁴, Rong Liu⁵

Affiliations

¹ The Faculty of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.
² The Faculty of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China; Organ Transplantation Department, The Third Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.
³ Department of General Surgery, Chinese People's Liberation Army (PLA) Strategic Support Force Characteristic Medical Center, Beijing, China.
⁴ The Faculty of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China. Electronic address: Zhimingzhao616@126.com.
⁵ The Faculty of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China. Electronic address: liurong301@126.com.

PMID: 35447362
DOI: 10.1016/j.ijsu.2022.106612

Abstract

Background: Radical antegrade modular pancreatosplenectomy (RAMPS), a new surgical approach for pancreatic ductal adenocarcinoma of the body and tail, has become increasingly accepted and performed in recent years. Robotic surgery has advantages over open and laparoscopic surgeries in terms of surgical vision and instrument flexibility. However, the lack of comprehension of the learning curve has limited its generalization. This study aimed to evaluate the learning curve of robotic posterior RAMPS.

Methods: Patients who underwent robotic posterior RAMPS between February 2017 and April 2021 at our institution were included in this study. Data on patient characteristics, perioperative outcomes, and pathological outcomes were summarized and analyzed. The cumulative sum (CUSUM) method was used to assess the learning curve and inflection points based on operation time and estimated blood loss.

Results: One hundred consecutive patients who underwent robotic posterior RAMPS were enrolled. The median operation time was 235.0 (interquartile range [IQR], 210.0-270.0) min, and the estimated blood loss was 210.0 (IQR, 165.0-245.0) mL. The grade 3/4 Clavien-Dindo complication rate was 8% (8/100). According to the CUSUM plot, the inflection points of the learning curve were 25 and 65 cases, dividing the case series into the learning (1-25 cases), plateau (26-65 cases), and maturation (66-100 cases) phases. The operation time was relatively high in the learning phase, reached a plateau between 25 and 65 cases (270.0 min vs. 220.0 min, p < 0.01), and decreased significantly in the maturation phase (p < 0.01). Estimated blood loss improved in the maturation phase compared to the learning phase (150.0 vs. 245.0 mL, p < 0.01). No significant differences in conversion rate, complications, or mortality were observed among the three phases.

Conclusion: The inflection points of the learning and plateau phases were the 25th and 65th cases, respectively. Robotic RAMPS is safe and feasible even in the learning phase.

Keywords: Learning curve; Pancreatic cancer; Robotic surgery.

MeSH terms

Humans
Laparoscopy* / adverse effects
Laparoscopy* / methods
Learning Curve
Operative Time
Pancreatectomy / methods
Pancreatic Neoplasms*
Retrospective Studies
Robotic Surgical Procedures* / adverse effects
Robotic Surgical Procedures* / methods