Standard operating procedures and learning curve analysis for surgical assistants in robot-assisted distal pancreatectomy.

Abstract

Robot-assisted pancreatic surgery (RPS) is increasingly adopted across institutions. While structured training and longitudinal skill acquisition are essential for optimal outcomes, the learning progression of surgical assistants in RPS remains inadequately characterized. This study presents our institution's standard operating procedures (SOP) for robot-assisted distal pancreatectomy (RDP) developed through a single-team cohort experience and defines the assistant learning curve based on operative time, thereby establishing evidence-based benchmarks for RPS training programs. In this retrospective study, data of consecutive patients who underwent RDP in our team from November 2022 to March 2025 were analyzed. The assistant learning curve was constructed using cumulative sum (CUSUM) analysis of operative time. The preoperative parameters, intraoperative outcomes, and postoperative metrics were compared between phases. Ninety-one patients were included in this study. Based on operative time analysis, the learning curve was stratified into two distinct phases: the initial learning phase (cases 1-43) and subsequent proficiency phase (cases 44-91). Operative duration and estimated blood loss were significantly greater during the learning phase compared to the proficiency phase. Among patients scheduled for spleen-preserving RDP, while overall spleen preservation rates were comparable between phases, proficiency phase cases demonstrated significantly superior splenic vessel preservation rates. Our RDP-specific SOP demonstrates safety and efficacy, with assistant proficiency significantly improving after 43 cases under expert supervision. Quantified learning thresholds provide validated benchmarks for structured robotic surgery training programs.