How to train and evaluate minimally invasive pancreas surgery

Vining, Charles C.; Hogg, Melissa E.

doi:10.1002/jso.25912

Cited by 29 publications

(39 citation statements)

References 67 publications

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“…To ensure the safe introduction of MIPRs, several training programs for both procedures were developed. [12][13][14][15] These training programs included video and virtual reality training, biotissue drills, and on-and off-site proctoring. The LAELAPS-1 training program for MIDP in The Netherlands resulted in a sevenfold increase in the use of this technique, lower conversion rates (from 38 to 8%), less blood loss, and shorter hospital stay compared with the outcomes before training.…”

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confidence: 99%

The Landmark Series: Minimally Invasive Pancreatic Resection

et al. 2020

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Background Pancreatic resections are among the most technically demanding procedures, including a high risk of potentially life-threatening complications and outcomes strongly correlated to hospital volume and individual surgeon experience. Minimally invasive pancreatic resections (MIPRs) have become a part of standard surgical practice worldwide over the last decade; however, in comparison with other surgical procedures, the implementation of minimally invasive approaches into clinical practice has been rather slow. Objective The aim of this study was to highlight and summarize the available randomized controlled trials (RCTs) evaluating the role of minimally invasive approaches in pancreatic surgery. Methods A WHO trial registry and Pubmed database literature search was performed to identify all RCTs comparing MIPRs (robot-assisted and/or laparoscopic distal pancreatectomy [DP] or pancreatoduodenectomy [PD]) with open pancreatic resections (OPRs). Results Overall, five RCTs on MIPR versus OPR have been published and seven RCTs are currently recruiting. For DP, the results of two RCTs were in favor of minimally invasive distal pancreatectomy (MIDP) in terms of shorter hospital stay and less intraoperative blood loss, with comparable morbidity and mortality. Regarding PD, two RCTs showed similar advantages for MIPD. However, concerns were raised after the early termination of the third multicenter RCT on MIPD versus open PD due to higher complication-related mortality in the laparoscopic group and no clear other demonstrable advantages. No RCTs on robot-assisted pancreatic procedures are available as yet. Conclusion At the current level of evidence, MIDP is thought to be safe and feasible, although oncological safety should be further evaluated. Based on the results of the RCTs conducted for PD, MIPD cannot be proclaimed as the superior alternative to open PD, although promising outcomes have been demonstrated by experienced centers. Future studies should provide answers to the role of robotic approaches in pancreatic surgery and aim to identity the subgroups of patients or indications with the greatest benefit of MIPRs.

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confidence: 99%

The Landmark Series: Minimally Invasive Pancreatic Resection

et al. 2020

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“…Increasing proficiency with robotic pancreatic surgery is reflected in a decrease in operative times as well as conversion rates. Other more sophisticated factors may include number of lymph nodes resected, blood loss, R-status, hospital stay, and 90-day complications and readmission as well [8] . Our initial experience with robotic pancreatic surgery revealed a conversion rate of one in four decreasing to one in 32 cases after overcoming the learning curve.…”

Section: Discussionmentioning

confidence: 99%

“…During the early stages of the learning curve, proficiency in DPS should be achieved [6] . However, learning curves can be considerably diminished by appropriate training, proficient mentorship and an experienced multidisciplinary team [7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

Robotic pancreaticoduodenectomy and splenopancreatectomy: technical aspects and review of literature

Tschuor¹,

Nagarkatti²,

Salibi³

et al. 2020

Mini-invasive Surg

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Robotic pancreatic surgery provides several advantages. Since the first report of a robotic-assisted distal pancreatectomy in 2001, total pancreatectomies, pancreatic tumor enucleations, pancreaticoduodenectomy, central pancreatectomy and Appleby procedures have been performed, indicating a promising future. The aim of this article is to describe our experience of robotic pancreatic surgery including technical aspects for pancreaticoduodenectomy and distal pancreatectomy. The current literature on feasibility, safety and early postoperative outcomes will be discussed.

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“…Many of these studies examined results for surgeons who did not have prior robotic training and during a period when the technical conduct of the operation was still being refined. Since these reports, robotic training has expanded dramatically and rigorous curricula developed specific to robotic pancreatic surgery 13–18 …”

Section: Introductionmentioning

confidence: 99%

Formal robotic training diminishes the learning curve for robotic pancreatoduodenectomy: Implications for new programs in complex robotic surgery

Schmidt

Harris

Musgrove

et al. 2020

Journal of Surgical Oncology

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IntroductionThe learning curve associated with robotic pancreatoduodenectomy (RPD) is a hurdle for new programs to achieve optimal results. Since early analysis, robotic training has recently expanded, and the RPD approach has been refined. The purpose of this study is to examine RPD outcomes for surgeons who implemented a new program after receiving formal RPD training to determine if such training reduces the learning curve.MethodsOutcomes for consecutive patients undergoing RPD at a single tertiary institution were compared to optimal RPD benchmarks from a previously reported learning curve analysis. Two surgical oncologists with formal RPD training performed all operations with one surgeon as bedside assistant and the other at the console.ResultsForty consecutive RPD operations were evaluated. Mean operative time was 354 ± 54 min, and blood loss was 300 ml. Length of stay was 7 days. Three patients (7.5%) underwent conversion to open. Pancreatic fistula affected five patients (12.5%). Operative time was stable over the study and lower than the reported benchmark. These RPD operative outcomes were similar to reported surgeon outcomes after the learning curve.ConclusionThis study suggests formal robotic training facilitates safe and efficient adoption of RPD for new programs, reducing or eliminating the learning curve.

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How to train and evaluate minimally invasive pancreas surgery

Cited by 29 publications

References 67 publications

The Landmark Series: Minimally Invasive Pancreatic Resection

The Landmark Series: Minimally Invasive Pancreatic Resection

Robotic pancreaticoduodenectomy and splenopancreatectomy: technical aspects and review of literature

Formal robotic training diminishes the learning curve for robotic pancreatoduodenectomy: Implications for new programs in complex robotic surgery

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