The Feasibility, Proficiency, and Mastery Learning Curves in 635 Robotic Pancreatoduodenectomies Following A Multicenter Training Program

Abstract

Objective: To assess the feasibility, proficiency, and mastery learning curves for robotic pancreatoduodenectomy (RPD) in "second-generation" RPD centers following a multicenter training program adhering to the IDEAL framework. Background: The long learning curves for RPD reported from "pioneering" expert centers may discourage centers interested in starting an RPD program. However, the feasibility, proficiency, and mastery learning curves may be shorter in "second-generation" centers that participated in dedicated RPD training programs, although data are lacking. We report on the learning curves for RPD in "second-generation" centers trained in a dedicated nationwide program. Methods: Post hoc analysis of all consecutive patients undergoing RPD in 7 centers that participated in the LAELAPS-3 training program, each with a minimum annual volume of 50 pancreatoduodenectomies, using the mandatory Dutch Pancreatic Cancer Audit (March 2016-December 2021). Cumulative sum analysis determined cutoffs for the 3 learning curves: operative time for the feasibility (1) risk-adjusted major complication (Clavien-Dindo grade ≥ III) for the proficiency, (2) and textbook outcome for the mastery, (3) learning curve. Outcomes before and after From the

Robotic versus open partial pancreatoduodenectomy (EUROPA): a randomised controlled stage 2b trial

“… 16 In a recently published post-hoc multicentre study, the learning cut-offs for feasibility, proficiency, and mastery learning curves for RPD were defined at 15, 62, and 84 procedures after a structured training program. 41 In our trial, all surgeons except two surpassed the recommended number of 40 RPDs and OPDs and underwent robotic training. The two cases operated by surgeons who had performed less than 40 PDs before the trial were included in the intention-to-treat but excluded in the per protocol set.…”

Current progress in robotic hepatobiliary and pancreatic surgery at a high‐volume center

“…[58][59][60] These institutions have preliminarily shown shortened learning curves for those who undergo a formal robotic training program within their fellowship or residency. [60][61][62] In 2020, our center developed the first completely robotic HPB surgery fellowship. This is a 1-year fellowship after completion of formal HPB or abdominal transplant training.…”

Early experience with robotic pancreatoduodenectomy versus open pancreatoduodenectomy: nationwide propensity-score-matched analysis

“…This programme included virtual reality and artificial organ training, followed by on-site proctoring during the first RPD procedures 7 . Although early results from the programme seemed promising in selected patients, a direct comparison with OPD is lacking 8 , 9 . Randomized controlled trials comparing RPD and OPD are currently lacking and the existing comparative studies are often small retrospective single-centre studies, prone to treatment allocation bias 10–12 .…”