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Review
. 2022 Jan 27;3(1):e111.
doi: 10.1097/AS9.0000000000000111. eCollection 2022 Mar.

Learning Curves in Open, Laparoscopic, and Robotic Pancreatic Surgery: A Systematic Review and Proposal of a Standardization

P C Müller  1 , C Kuemmerli  2 , A Cizmic  3 , S Sinz  4 , P Probst  3 , M de Santibanes  5 , S V Shrikhande  6 , C Tschuor  7 , M Loos  3 , A Mehrabi  3 , K Z'graggen  1 , B P Müller-Stich  3 , T Hackert  3 , M W Büchler  3 , F Nickel  3
Affiliations
Review

Learning Curves in Open, Laparoscopic, and Robotic Pancreatic Surgery: A Systematic Review and Proposal of a Standardization

"V体育ios版" P C Müller et al. Ann Surg Open. .

Abstract

Objective: To depict and analyze learning curves for open, laparoscopic, and robotic pancreatoduodenectomy (PD) and distal pancreatectomy (DP). VSports手机版.

Background: Formal training is recommended for safe introduction of pancreatic surgery but definitions of learning curves vary and have not been standardized. V体育安卓版.

Methods: A systematic search on PubMed, Web of Science, and CENTRAL databases identified studies on learning curves in pancreatic surgery. Primary outcome was the number needed to reach the learning curve as defined by the included studies V体育ios版. Secondary outcomes included endpoints defining learning curves, methods of analysis (statistical/arbitrary), and classification of learning phases. .

Results: Out of 1115 articles, 66 studies with 14,206 patients were included. Thirty-five studies (53%) based the learning curve analysis on statistical calculations. Most often used parameters to define learning curves were operative time (n = 51), blood loss (n = 17), and complications (n = 10) VSports最新版本. The number of procedures to surpass a first phase of learning curve was 30 (20-50) for open PD, 39 (11-60) for laparoscopic PD, 25 (8-100) for robotic PD (P = 0. 521), 16 (3-17) for laparoscopic DP, and 15 (5-37) for robotic DP (P = 0. 914). In a three-phase model, intraoperative parameters improved earlier (first to second phase: operating time -15%, blood loss -29%) whereas postoperative parameters improved later (second to third phase: complications -46%, postoperative pancreatic fistula -48%). Studies with higher sample sizes showed higher numbers of procedures needed to overcome the learning curve (rho = 0. 64, P < 0. 001). .

Conclusions: This study summarizes learning curves for open-, laparoscopic-, and robotic pancreatic surgery with different definitions, analysis methods, and confounding factors. A standardized reporting of learning curves and definition of phases (competency, proficiency, mastery) is desirable and proposed. V体育平台登录.

Keywords: distal pancreatectomy; learning curve; minimally invasive pancreatic surgery; pancreatic surgery; pancreaticoduodenectomy; pancreatoduodenectomy; robotic surgery VSports注册入口. .

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Figures

None
Graphical abstract
FIGURE 1.
FIGURE 1.
PRISMA flow diagram for the systematic review.
FIGURE 2.
FIGURE 2.
Evolution of the intra- and postoperative outcome parameters over the different phases of the learning curve. Operative time (A) and blood loss (B), decreased at an earlier stage while postoperative parameters such as complications (C) and POPF (D) decreased at a later stage. POPF, postoperative pancreatic fistula.
FIGURE 3.
FIGURE 3.
Relation of the study population size and the minimal number of procedures to overcome the learning curve of the most frequently used endpoint (operative time) for pancreatoduodenectomy and distal pancreatectomy.
FIGURE 4.
FIGURE 4.
A: Learning curve of pancreatoduodenectomies per endpoint, either intraoperative (operative time, blood loss, and conversion) or postoperative (overall complications, length of stay, and POPF). The size of the bubble depicts the study sample size. B: Trend of operative time from start until the late phases/procedures. PD indicates pancreatoduodenectomy; POPF, postoperative pancreatic fistula.
FIGURE 5.
FIGURE 5.
A: Learning curve of distal pancreatectomies per endpoint, either intraoperative (operative time, blood loss, and conversion) or postoperative (overall complications, length of stay, and POPF). The size of the bubble depicts the study sample size. B: Trend of operative time from start until the late phases/procedures. PD, pancreatoduodenectomy; POPF, postoperative pancreatic fistula.
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