Institutional learning curve and factors of prolonged operation time of robotic distal pancreatectomy: An analysis of an initial 117 cases

IF 2.9 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Yuki Hirata, Laura Prakash, Jess Maxwell, Rebecca Snyder, Michael Kim, Hop Tran Cao, Ching-Wei D. Tzeng, Jefferey E. Lee, Matthew H. G. Katz, Naruhiko Ikoma
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Abstract

Background

The granular methods by which centers can safely implement and effectively expand robotic distal pancreatectomy (RDP), including those related to appropriate patient selection during the learning curve period, remain unclear. This study aimed to verify that our strategic robotic surgical oncology program effectively implemented RDP as standard practice and to identify factors associated with prolonged operation time.

Materials and Methods

We performed a detailed analysis of the intraoperative and short-term outcomes of consecutive patients (October 2018–September 2023) undergoing RDP at our center, beginning with the first patient in our program. Operation time was analyzed using a cumulative sum chart (CUSUM), and factors associated with prolonged operation time were analyzed.

Results

Throughout the study period, five surgeons performed RDP for 117 patients. The CUSUM analysis indicated our center required 18 cases to overcome the initial learning phase and 43 additional cases to become proficient. In contrast, when comparing short-term outcomes across the three observation periods, there were no significant changes in the incidence of ACCORDION grade ≥3 pancreatic fistulas (p = 0.684), or readmission rates (p = 0.457). A multivariable analysis revealed BMI ≥30 in male, the presence of pancreatitis or fibrosis, and the performance of concomitant procedures were associated with extended operation times, while BMI ≥30 in female was not.

Conclusions

Although an institutional learning curve was observed, our program enabled the safe implementation of RDP and successfully expanded the number of primary operating surgeons while maintaining stable short-term outcomes. The absence of an impact of high BMI on operation time in female patients suggests a notable advantage of robotic approach for these individuals.

Abstract Image

117例机器人胰远端切除术机构学习曲线及延长手术时间的因素分析
中心可以安全实施和有效扩展机器人远端胰腺切除术(RDP)的颗粒方法,包括在学习曲线期间适当选择患者的方法,目前尚不清楚。本研究旨在验证我们的战略机器人外科肿瘤学项目有效地将RDP作为标准实践,并确定与延长手术时间相关的因素。材料和方法我们从项目中的第一位患者开始,对连续患者(2018年10月至2023年9月)在我们中心接受RDP的术中和短期结果进行了详细分析。使用累积和图(CUSUM)分析手术时间,并分析与延长手术时间相关的因素。结果在整个研究期间,5名外科医生对117例患者进行了RDP手术。CUSUM的分析表明,我们的中心需要18个案例才能克服最初的学习阶段,另外需要43个案例才能熟练。相反,当比较三个观察期的短期结果时,ACCORDION分级≥3级胰腺瘘的发生率(p = 0.684)或再入院率(p = 0.457)没有显著变化。一项多变量分析显示,男性BMI≥30、胰腺炎或纤维化的存在以及伴随手术的表现与延长手术时间有关,而女性BMI≥30与延长手术时间无关。结论:虽然观察到一个机构学习曲线,但我们的计划使RDP的安全实施成为可能,并成功地扩大了初级手术医生的数量,同时保持了稳定的短期结果。女性患者的高BMI对手术时间没有影响,这表明机器人入路对这些个体具有显著的优势。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of Gastroenterological Surgery
Annals of Gastroenterological Surgery GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.30
自引率
11.10%
发文量
98
审稿时长
11 weeks
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