Laparoscopic distal pancreatectomy: what factors are related to the learning curve?

Ricci, Claudio; Casadei, Riccardo; Buscemi, Salvatore; Taffurelli, Giovanni; D’Ambra, Marielda; Pacilio, Carlo Alberto; Minni, Francesco

doi:10.1007/s00595-014-0872-x

Cited by 72 publications

(66 citation statements)

References 13 publications

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“…Ricci et al [18] examined 32 cases involving laparoscopic distal pancreatectomy performed by a single surgeon (pancreatic surgeon), with the primary endpoint being operation time and the secondary endpoint being the conversion to laparotomy, rate of complication, mortality rate, postoperative hospital stay, and number of unscheduled splenectomies. The ROC curve is used as a statistical method to calculate the cut-off value for the learning curve, as was conducted in the current study.…”

Section: Discussionmentioning

confidence: 99%

Learning curve for laparoscopic Heller myotomy and Dor fundoplication for achalasia

et al. 2017

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PurposeAlthough laparoscopic Heller myotomy and Dor fundoplication (LHD) is widely performed to address achalasia, little is known about the learning curve for this technique. We assessed the learning curve for performing LHD.MethodsOf the 514 cases with LHD performed between August 1994 and March 2016, the surgical outcomes of 463 cases were evaluated after excluding 50 cases with reduced port surgery and one case with the simultaneous performance of laparoscopic distal partial gastrectomy. A receiver operating characteristic (ROC) curve analysis was used to identify the cut-off value for the number of surgical experiences necessary to become proficient with LHD, which was defined as the completion of the learning curve.ResultsWe defined the completion of the learning curve when the following 3 conditions were satisfied. 1) The operation time was less than 165 minutes. 2) There was no blood loss. 3) There was no intraoperative complication. In order to establish the appropriate number of surgical experiences required to complete the learning curve, the cut-off value was evaluated by using a ROC curve (AUC 0.717, p < 0.001). Finally, we identified the cut-off value as 16 surgical cases (sensitivity 0.706, specificity 0.646).ConclusionLearning curve seems to complete after performing 16 cases.

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Section: Discussionmentioning

confidence: 99%

Learning curve for laparoscopic Heller myotomy and Dor fundoplication for achalasia

et al. 2017

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“…However, most pancreatic surgeons encounter complications after DP, especially postoperative pancreatic fistula (POPF). The incidence of POPF after DP has been reported to range from 18.6 to 64.9 % [2][3][4]. POPF causes a variety of postoperative complications, such as intra-abdominal abscess, delayed gastric emptying, and postoperative hemorrhage, due to pseudoaneurysm rupture.…”

Section: Introductionmentioning

confidence: 99%

Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy

et al. 2016

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Postoperative pancreatic fistula (POPF) is the most frequent and serious complication after distal pancreatectomy (DP) and often leads to other postoperative complications. Numerous studies have been conducted to clarify the risk factors for POPF after DP, and to also determine effective prophylactic treatments. In this article, we review the current evidence on the risk factors for POPF after DP, and also provide new evidence to support the currently implemented prophylactic measures against POPF after DP. The patient-related and surgery-related risk factors and risk factors specific to staplers are discussed. Several studies have suggested that a thick pancreas is a risk factor for POPF using a stapler and that a higher stapler height or pancreatoenteric anastomosis might be useful for preventing POPF when transecting a thick pancreas. Various methods, such as stapler closure, procedures that may be performed in addition to stapler closure, pancreatoenteric anastomosis, pancreatic transection devices, laparoscopic surgery, pancreatic stenting, stump coverage, and somatostatin analogs, have been tested and in comparison with conventional procedures in case-control studies and randomized, controlled trials. Although some studies have shown the superiority of these methods to the conventional procedures, a consensus on precautionary measures that can be taken against POPF remains to be established. Further investigation is necessary to develop a reliable strategy for preventing POPF and to improve the outcomes of patients after DP.

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“…In a similar series of 55 patients undergoing robotic distal pancreatectomy, the inflection point for operative time occurred at 10 procedures; this was associated with an average operative time decreased from 421 to 249 minutes 26 . By comparison, Braga et al 27 reported operative time stabilized after 20 laparoscopic distal pancreatectomy procedures, and Ricci et al 28 reported that the laparoscopic distal pancreatectomy learning curve had been overcome by 17 procedures.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive distal pancreatectomy and the cost of conversion

Stewart

Wong

Selby

et al. 2020

Journal of Surgical Oncology

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Background Minimally invasive surgery (MIS) is preferred for distal pancreatectomy but is not always attempted due to the risk of conversion to open. We hypothesized that the total cost for MIS converted to open procedures would be comparable to those that started open. Methods A prospectively collected institutional registry (2011‐2017) was reviewed for demographic, clinical, and perioperative cost data for patients undergoing distal pancreatectomy. Results There were 80 patients who underwent distal pancreatectomy: 41 open, 39 MIS (11 laparoscopic and 28 robotic). Conversion to open occurred in 14 of 39 (36%, 3 laparoscopic and 11 robotic). Length of stay was shorter for the MIS completed (6 days; range, 3‐8), and MIS converted to open (7 days; range, 4‐10) groups, compared with open (10 days; range, 5‐36; P = .003). Laparoscopic cases were the least expensive (P = .02). Robotic converted to open procedures had the highest operating room cost. However, the total cost for robotic converted to open cohort was similar to the open cohort due to cost savings associated with a shorter length of stay. Conclusions Despite the higher intraoperative costs of robotic surgery, there is no significant overall financial penalty for conversion to open. Financial considerations should not play a role in selecting a robotic or open approach.

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Laparoscopic distal pancreatectomy: what factors are related to the learning curve?

Abstract: The length of the operation seems to be the main factor related to the CLC for laparoscopic distal pancreatectomy. The learning curve could be considered to be completed after about 17 procedures if performed by surgeons experienced with laparoscopic techniques at high-volume centers.

Cited by 72 publications

References 13 publications

Learning curve for laparoscopic Heller myotomy and Dor fundoplication for achalasia

Learning curve for laparoscopic Heller myotomy and Dor fundoplication for achalasia

Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy

Minimally invasive distal pancreatectomy and the cost of conversion

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