Learning curves in minimally invasive pancreatic surgery: a systematic review

Fung, Gayle Tin Yee; Sha, Menazir; Kunduzi, Basir; Froghi, Farid; Rehman, Saad; Froghi, Saied

doi:10.1007/s00423-022-02470-3

Cited by 29 publications

(25 citation statements)

References 35 publications

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“…Further, data on the standardized assessment of a learning curve are still missing. An attempt to define median learning curves for minimally invasive pancreatic surgery was recently done in a systematic review by Fung et al ., 36 reporting a median learning curve in DP of 17 (10–30) and 23.5 (7–40) cases for laparoscopic and robotic procedures respectively. The median learning curve for PD was reported to have been achieved at 30 (4–60) cases for the laparoscopic approach and 36.5 (20–80) cases for the robotic approach 36 .…”

Section: Discussionmentioning

confidence: 99%

“…An attempt to define median learning curves for minimally invasive pancreatic surgery was recently done in a systematic review by Fung et al ., 36 reporting a median learning curve in DP of 17 (10–30) and 23.5 (7–40) cases for laparoscopic and robotic procedures respectively. The median learning curve for PD was reported to have been achieved at 30 (4–60) cases for the laparoscopic approach and 36.5 (20–80) cases for the robotic approach 36 . Comparing surgeon experience reported in the included studies with extrapolated learning curves from the literature 28 , 36 , it becomes evident that not all surgeons reached sufficient expertise in minimally invasive pancreatic surgery before the start of the investigation.…”

Section: Discussionmentioning

confidence: 99%

“…The median learning curve for PD was reported to have been achieved at 30 (4–60) cases for the laparoscopic approach and 36.5 (20–80) cases for the robotic approach 36 . Comparing surgeon experience reported in the included studies with extrapolated learning curves from the literature 28 , 36 , it becomes evident that not all surgeons reached sufficient expertise in minimally invasive pancreatic surgery before the start of the investigation. Nevertheless, postoperative mortality rate and morbidity rate between minimally invasive and open pancreatic surgery seem to be comparable.…”

Section: Discussionmentioning

confidence: 99%

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Minimally invasiveversusopen pancreatic surgery: meta-analysis of randomized clinical trials

et al. 2023

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Background Widespread implementation of the minimally invasive technique in pancreatic surgery has proven to be challenging. The aim of this study was to compare the perioperative outcomes of minimally invasive (laparoscopic and robotic) pancreatic surgery with open pancreatic surgery using data obtained from RCTs. Methods A literature search was done using Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Web of Science; all available RCTs comparing minimally invasive pancreatic surgery and open pancreatic surgery in adults requiring elective distal pancreatectomy or partial pancreatoduodenectomy were included. Outcomes were mortality rate, general and pancreatic surgery specific morbidity rate, and length of hospital stay. Results Six RCTs with 984 patients were included; 99.0 per cent (486) of minimally invasive procedures were performed laparoscopically and 1.0 per cent (five) robotically. In minimally invasive pancreatic surgery, length of hospital stay (−1.3 days, −2 to −0.5, P = 0.001) and intraoperative blood loss (−137 ml, −182 to −92, P < 0.001) were reduced. In the subgroup analysis, reduction in length of hospital stay was only present for minimally invasive distal pancreatectomy (−2 days, −2.3 to −1.7, P < 0.001). A minimally invasive approach showed reductions in surgical site infections (OR 0.4, 0.1 to 0.96, P = 0.040) and intraoperative blood loss (−131 ml, −173 to −89, P < 0.001) with a 75 min longer duration of surgery (42 to 108 min, P < 0.001) only in partial pancreatoduodenectomy. No significant differences were found with regards to mortality rate and postoperative complications. Conclusion This meta-analysis presents level 1 evidence of reduced length of hospital stay and intraoperative blood loss in minimally invasive pancreatic surgery compared with open pancreatic surgery. Morbidity rate and mortality rate were comparable, but longer duration of surgery in minimally invasive partial pancreatoduodenectomy hints that this technique in partial pancreatoduodenectomy is technically more challenging than in distal pancreatectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Minimally invasiveversusopen pancreatic surgery: meta-analysis of randomized clinical trials

et al. 2023

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“…Fung et al reported the learning curve of laparoscopic distal pancreatectomy as 17 cases in their systematic review. [ 16 ] It is obvious that it will take a long time to reach this number for surgeons working in centers with low patient volume and young surgeons. Such reasons have pushed surgeons to search for new ones.…”

Section: Discussionmentioning

confidence: 99%

The contribution of laparoscopic distal pancreatectomy videos on YouTube to the learning curve in the COVID-19 pandemic

et al. 2022

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There is no standardization in videos uploaded to Youtube. Were the videos capable of contributing to adequate technical quality and surgical training? We are aiming to answer these questions in this paper. It is a cross-sectional study. In January 2022, we searched the Youtube platform using the keyword “distal pancreatectomy.” The substantiality, transparency, reliability, quality, popularity and educational values of the video content were evaluated after exclusion criteria. These parameters were evaluated using we the modified Journal of American Medical Association benchmark criteria, Global Quality Score (GQS), Video Power Index, modified laparoscopic pancreatectomy scoring system. The videos uploaded after the pandemic had a statistically significant higher GQS score (P < .001). Video Power Index, like GQS, had a statistically significant difference before and after the pandemic. (P = .046). There was no significant difference in the evaluation of the reliability and substantiality. Until the development of Youtube videos is completed, peer-reviewed, more reliable and content-rich online education platforms should be preferred in the first place. Care should be taken to watch selected videos on Youtube videos.

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“…The threefold increase in anastomotic leak rate is not explained by the recognized risk factors of age, sex, neoadjuvant therapy, tumour height or an open surgical approach [20–23]. In colonic and pancreatic surgery, an increase in intraoperative time and bleeding rates has been reported in LVS, both of which have been shown to increase anastomotic leak rates, but this study does not evaluate these factors [5, 24–27].…”

Section: Discussionmentioning

confidence: 99%

Impact of surgeon volume on 18‐month unclosed ileostomy rate after restorative rectal cancer resection

et al. 2022

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Aim:The impact of surgeon volume on 18-month unclosed ileostomy rates after rectal cancer surgery has not been fully explored. The aim of this study was to describe the effect of surgeon volume and evaluate factors predictive of an unclosed ileostomy.Method: Patients undergoing anterior resection with a diverting ileostomy for rectal cancer from March 2004 to October 2018 were identified from a prospectively maintained database. The unclosed ileostomy rate was determined by those with an unclosed ileostomy at 18 months. High-and low-volume surgeons (HVS and LVS, respectively) were classed as those performing five or more or fewer than five rectal cancer resections per year, respectively. Data on sex, age, American Society of Anesthesiologists grade, neoadjuvant chemoradiotherapy (CRT), tumour height, T-stage, anastomotic leak, surgical approach and adjuvant chemotherapy were also collected. Factors predictive of an unclosed ileostomy at 18 months were explored using a multivariate binary logistic regression analysis.Results: A total of 415 patients (62.4% male) with a median age of 67 were eligible for analysis. Of these, 115 (27.7%) had an unclosed ileostomy at 18 months. HVS had an unclosed ileostomy rate of 24.6% (72/292) compared with 34.9% (43/123) for LVS. Volume was associated with an unclosed ileostomy in univariable analysis (p = 0.032) but not in multivariate analysis (OR 1.75, 95% CI 0.92-3.32, p = 0.08). Independent factors predictive of an unclosed ileostomy were anastomotic leak (OR 10.41, p < 0.01),

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Learning curves in minimally invasive pancreatic surgery: a systematic review

Cited by 29 publications

References 35 publications

Minimally invasiveversusopen pancreatic surgery: meta-analysis of randomized clinical trials

Minimally invasiveversusopen pancreatic surgery: meta-analysis of randomized clinical trials

The contribution of laparoscopic distal pancreatectomy videos on YouTube to the learning curve in the COVID-19 pandemic

Impact of surgeon volume on 18‐month unclosed ileostomy rate after restorative rectal cancer resection

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