Implementation and training with laparoscopic distal pancreatectomy: 23-year experience from a high-volume center.
Adenocarcinoma
Conversion
Laparoscopy
Morbidity
Pancreatectomy
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
01 2022
01 2022
Historique:
received:
06
10
2020
accepted:
09
01
2021
pubmed:
4
2
2021
medline:
3
3
2022
entrez:
3
2
2021
Statut:
ppublish
Résumé
Distal pancreatectomy is the most common procedure in minimally-invasive pancreatic surgery. Data in the literature suggest that the learning curve flattens after performing up to 30 procedures. However, the exact number remains unclear. The implementation and training with laparoscopic distal pancreatectomy (LDP) in a high-volume center were studied between 1997 and 2020. Perioperative outcomes and factors related to conversion were assessed. The individual experiences of four different surgeons (pioneer and adopters) performing LDP on a regular basis were examined. Six hundred forty LDPs were done accounting for 95% of all distal pancreatectomies performed throughout the study period. Conversion was needed in 14 (2.2%) patients due to intraoperative bleeding or tumor adherence to the major vasculature. Overall morbidity and mortality rates were 35 and 0.6%, respectively. Intra- and postoperative outcomes did not change for any of the surgeons within their first 40 cases. Operative time significantly decreased after the first 80 cases for the pioneer surgeon and did not change afterwards although the proportion of ductal adenocarcinoma increased. Tumor size increased after the first 80 cases for the first adopter without affecting the operative time. In this nearly unselected cohort, no significant changes in surgical outcomes were observed throughout the first 40 LDPs for different surgeons. The exact number of procedures required to overcome the learning curve is difficult to determine as it seems to depend on patient selection policy and specifics of surgical training at the corresponding center.
Sections du résumé
BACKGROUND
Distal pancreatectomy is the most common procedure in minimally-invasive pancreatic surgery. Data in the literature suggest that the learning curve flattens after performing up to 30 procedures. However, the exact number remains unclear.
METHODS
The implementation and training with laparoscopic distal pancreatectomy (LDP) in a high-volume center were studied between 1997 and 2020. Perioperative outcomes and factors related to conversion were assessed. The individual experiences of four different surgeons (pioneer and adopters) performing LDP on a regular basis were examined.
RESULTS
Six hundred forty LDPs were done accounting for 95% of all distal pancreatectomies performed throughout the study period. Conversion was needed in 14 (2.2%) patients due to intraoperative bleeding or tumor adherence to the major vasculature. Overall morbidity and mortality rates were 35 and 0.6%, respectively. Intra- and postoperative outcomes did not change for any of the surgeons within their first 40 cases. Operative time significantly decreased after the first 80 cases for the pioneer surgeon and did not change afterwards although the proportion of ductal adenocarcinoma increased. Tumor size increased after the first 80 cases for the first adopter without affecting the operative time.
CONCLUSIONS
In this nearly unselected cohort, no significant changes in surgical outcomes were observed throughout the first 40 LDPs for different surgeons. The exact number of procedures required to overcome the learning curve is difficult to determine as it seems to depend on patient selection policy and specifics of surgical training at the corresponding center.
Identifiants
pubmed: 33534075
doi: 10.1007/s00464-021-08306-3
pii: 10.1007/s00464-021-08306-3
pmc: PMC8741682
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
468-479Informations de copyright
© 2021. The Author(s).
Références
HPB (Oxford). 2017 Jul;19(7):595-602
pubmed: 28400087
J Am Coll Surg. 2017 May;224(5):826-832.e1
pubmed: 28126547
Surg Laparosc Endosc Percutan Tech. 2015 Aug;25(4):297-302
pubmed: 26147049
ISRN Surg. 2013 May 16;2013:625093
pubmed: 23762627
Surg Endosc. 2018 Sep;32(9):3839-3845
pubmed: 29435756
Surgery. 2007 Jul;142(1):20-5
pubmed: 17629996
Asian J Endosc Surg. 2014 Nov;7(4):295-300
pubmed: 25296944
HPB (Oxford). 2017 Mar;19(3):190-204
pubmed: 28215904
Surgery. 2017 Nov;162(5):1040-1047
pubmed: 28866314
Minim Invasive Ther Allied Technol. 2005;14(4):257-61
pubmed: 16754172
J Gastrointest Surg. 2016 Jan;20(1):77-84; discussion 84
pubmed: 26493976
HPB (Oxford). 2017 Mar;19(3):171-177
pubmed: 28189345
Ann Surg. 2009 Aug;250(2):177-86
pubmed: 19638919
Br J Surg. 2010 Jun;97(6):902-9
pubmed: 20474000
Surg Endosc. 2015 Jul;29(7):1952-62
pubmed: 25303912
Ann Surg. 2019 Jan;269(1):2-9
pubmed: 30080726
Surgery. 2017 Mar;161(3):584-591
pubmed: 28040257
Surg Endosc. 2017 May;31(5):2023-2041
pubmed: 28205034
Surg Endosc. 2019 Jan;33(1):88-93
pubmed: 29934868
Br J Surg. 2019 Nov;106(12):1657-1665
pubmed: 31454072
HPB (Oxford). 2018 Apr;20(4):356-363
pubmed: 29191691
Surg Oncol. 2018 Mar;27(1):A10-A15
pubmed: 29371066
Br J Surg. 2020 Sep;107(10):1281-1288
pubmed: 32259297
Surg Endosc. 2004 Mar;18(3):407-11
pubmed: 14752628
HPB (Oxford). 2016 Feb;18(2):170-176
pubmed: 26902136
Ann Surg Oncol. 2017 Nov;24(12):3725-3731
pubmed: 28849407
J Laparoendosc Adv Surg Tech A. 2016 Jun;26(6):470-4
pubmed: 27149307
Ann Surg. 2020 Jan;271(1):1-14
pubmed: 31567509
Surgery. 2014 Jul;156(1):1-14
pubmed: 24856668
Surg Today. 2015 Jan;45(1):50-6
pubmed: 24610347
Updates Surg. 2012 Sep;64(3):179-83
pubmed: 22763577