• Maurice J W Zwart, Carolijn L M Nota, Thijs de Rooij, Jony van Hilst, Wouter W Te Riele, Hjalmar C van Santvoort, Jeroen Hagendoorn, Inne H M Borei Rinkes, Jacob L van Dam, Anouk E J Latenstein, Kosei Takagi, Khé T C Tran, Jennifer Schreinemakers, George P van der Schelling, Jan H Wijsman, Sebastiaan Festen, Freek Daams, Misha D Luyer, de HinghIgnace H J TIHJTDepartment of Surgery, Catharina Hospital, Eindhoven, the Netherlands., Jan S D Mieog, Bert A Bonsing, Daan J Lips, HilalMohammed AbuMADepartment of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK.Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy., Olivier R Busch, Olivier Saint-Marc, Herbert J Zehl, Amer H Zureikat, Melissa E Hogg, I Quintus Molenaar, Marc G Besselink, KoerkampBas GrootBGDepartment of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands., and Dutch Pancreatic Cancer Group.
• Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
• Ann. Surg. 2022 Dec 1; 276 (6): e886e895e886-e895.

ObjectiveTo assess feasibility and safety of a multicenter training program in robotic pancreatoduodenectomy (RPD) adhering to the IDEAL framework for implementation of surgical innovation.BackgroundGood results for RPD have been reported from single center studies. However, data on feasibility and safety of implementation through a multicenter training program in RPD are lacking.MethodsA multicenter training program in RPD was designed together with the University of Pittsburgh Medical Center, including an online video bank, robot simulation exercises, biotissue drills, and on-site proctoring. Benchmark patients were based on the criteria of Clavien. Outcomes were collected prospectively (March 2016-October 2019). Cumulative sum analysis of operative time was performed to distinguish the first and second phase of the learning curve. Outcomes were compared between both phases of the learning curve. Trends in nationwide use of robotic and laparoscopic PD were assessed in the Dutch Pancreatic Cancer Audit.ResultsOverall, 275 RPD procedures were performed in seven centers by 15 trained surgeons. The recent benchmark criteria for low-risk PD were met by 125 (45.5%) patients. The conversion rate was 6.5% (n = 18) and median blood loss 250ml [interquartile range (IQR) 150-500]. The rate of Clavien-Dindo grade ≥III complications was 44.4% (n = 122), postoperative pancreatic fistula (grade B/C) rate 23.6% (n = 65), 90-day complication-related mortality 2.5% (n = 7) and 90-day cancer-related mortality 2.2.% (n = 6). Median postoperative hospital stay was 12 days (IQR 8-20). In the subgroup of patients with pancreatic cancer (n = 80), the major complication rate was 31.3% and POPF rate was 10%. Cumulative sum analysis for operative time found a learning curve inflection point at 22 RPDs (IQR 10-35) with similar rates of Clavien-Dindo grade ≥III complications in the first and second phase (43.4% vs 43.8%, P = 0.956, respectively). During the study period the nationwide use of laparoscopic PD reduced from 15% to 1%, whereas the use of RPD increased from 0% to 25%.ConclusionsThis multicenter RPD training program in centers with sufficient surgical volume was found to be feasible without a negative impact of the learning curve on clinical outcomes.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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