Learning curve of robotic distal pancreatectomy (DP) and pancreaticoduodenectomy (PD) - experience of a high-volume centre

Surgical techniques for pancreatic cancer resection have been profoundly revolutionized by robotic techniques. Since implementing the robotic platform at our Surgery Department, the robotic pancreatic surgical procedure has been optimized according to a standard operating procedure. The study aimed to determine the learning curve for robotic distal pancreatectomy (DP) and pancreaticoduodenectomy (PD).Patients undergoing robotic DP and PD at our academic centre between 2017 and 2020 were considered. Primary endpoints were operative time, intraoperative blood loss, and hospital stay. Secondary endpoints were postoperative complications and oncologic outcome. The learning curve for both procedures was determined by CUSUM analysis. Based on CUSUM analysis, statistical improvements between the early and late group were analyzed for each procedure. The learning curve included 18 cases for DP. Operative time was significantly reduced after 18 patients (213 min vs 142 min, p< 0.001). Statistically significant improvements occurred after 18 cases for estimated blood loss (300 ml vs 100 ml, p=0.03). Hospital stay was significantly reduced over the whole study period. For PD, the learning curve included 24 cases. After 24 cases, operative time (359 min vs 271 min, p< 0.001) and estimated blood loss (350 ml vs 100 m, p< 0.001) were significantly reduced. Oncologic outcome including resection margin clearance and number of lymph node harvest was not affected by the implementation of the robotic technique and warranted for each case-independent from the early or late group. Implementing the robotic platform for complex pancreatic resections can be achieved within a short time frame in a high-volume centre with specific robotic training and long-term surgical experience.

Publication History

Article published online:
07 September 2021