Abstract
Introduction
Laparoscopic pancreaticoduodenectomy (LPD) is a challenging procedure. We investigated
the learning curve (LC) for LPD with a multidimensional analysis.
Methods
Data of patients undergoing LPD between 2017 and 2021, operated by a single surgeon,
were considered. A multidimensional assessment of the LC was performed through Cumulative
Sum (CUSUM) and Risk-Adjusted (RA)-CUSUM analysis.
Results
113 patients were selected. Rates of conversion, overall postoperative complication,
severe complication and mortality were 4%, 53%, 29% and 4%, respectively. RA-CUSUM
analysis showed a LC with three phases: competency (procedures 1–51), proficiency
(procedures 52–94), and mastery (after procedure 94). Operative time was lower in
both phase two (588.17 vs 541.13 min, p = 0.001) and three (534.72 vs 541.13 min,
p = 0.004) with respect to phase one. Severe complication rate was lower in mastery
as compared to competency phase (42% vs 6%, p = 0.005). During mastery phase a greater
number of lymph nodes was harvested in comparison to proficiency phase.
Conclusions
According to our LC analysis, 52 procedures were required to achieve technical competency
in LPD. Mastery, which corresponded to a reduction in operative time and surgical
failures, was acquired after 94 procedures.
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Article info
Publication history
Published online: February 20, 2023
Accepted:
February 10,
2023
Received:
July 28,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
