• Philip C Müller, Christoph Kuemmerli, Adrian T Billeter, Baiyong Shen, Jiabin Jin, Felix Nickel, Cristiano Guidetti, Emanuele Kauffmann, Julia Purchla, Christoph Tschuor, KrohnPaul SunoPSDepartment of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark., Stefan K Burgdorf, Jan Philipp Jonas, Felix J Bussmann, Olivier Saint-Marc, Abdallah Iben-Khayat, Paul C M Andel, Izaak Quintus Molenaar, Ulrich Wellner, Tobias Keck, Beat Moeckli, Christian Toso, Fabrizio Di Benedetto, Valentina Valle, Pier Giulianotti, Didier Roulin, John B Martinie, Martina Rama, Harish Lavu, Charles Yeo, Parit T Mavani, Mihir M Shah, David A Kooby, Jin He, Ugo Boggi, Thilo Hackert, Borel-RinkesInne H MIHM0000-0003-2122-7207Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands., Beat P Müller, and Pierre-Alain Clavien.
• Department of Surgery, Clarunis University Digestive Health Care Center, University Hospital Basel, Basel, Switzerland.
• Ann. Surg. 2024 Nov 19.

ObjectiveThe aim of this study was to evaluate the different phases of the learning curve for robotic distal pancreatectomy (RDP) in international expert centers.Summary Background DataRDP is an emerging minimally invasive approach; however, only limited, mostly single center data are available on its safe implementation, including the learning curve.MethodsConsecutive patients undergoing elective RDP from 16 expert centers across three continents were included to assess the learning curve. Based on the first 100 RDPs at each center, three cutoffs were used to define the learning curve: operative time for competency, major complications (Clavien-Dindo grade ≥III) for proficiency, and textbook outcome for mastery. Clinical outcomes before and after the cutoffs were compared.ResultsThe learning curve analysis was conducted on 1109 of 2403 RDPs. Competency, proficiency, and mastery, respectively, were reached after 46, 63, and 73 RDP procedures. After competency, operative time decreased from 245 to 235 minutes (P=0.002). Attaining proficiency was reflected by a reduction in the rate of major complications from 20% to 15% (P=0.012), and mastery was associated with a higher proportion of patients with textbook outcome (71% vs. 63%; P=0.028). The postoperative pancreatic fistula rate remained stable along the learning curve, ranging between 18.5% and 21.5%. Previous laparoscopic experience accelerated the learning process by virtue of reduced operative time and an earlier decrease in major complications.ConclusionCompetency, proficiency, and mastery for RDP were reached after 46, 63, and 73 procedures, respectively, at international expert centers. The findings highlight that the learning curves for intraoperative parameters are completed earlier; however, extensive experience is needed to master RDP.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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