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Background <p>Robotic pancreatoduodenectomy (RPD) is a complex operation consisting of multiple surgical steps and requires significant experience to achieve efficiency. However, no studies have specifically examined the learning curve for individual steps of RPD. Therefore, we investigated the learning curve for each step of RPD in detail. The factors affecting the total operative time in RPD were also evaluated.</p> Methods <p>Data from the initial consecutive RPD cases at our institution were analyzed. Cumulative sum (CUSUM) analysis was used for total and step-specific operative time (6 resection steps and 3 reconstruction steps). Factors associated with total operative time were identified by multivariable linear regression analysis.</p> Results <p>Among 73 cases, the mean total operative time decreased from 539&#xa0;min for the first 20 cases to 445&#xa0;min for cases 61 to 73. Almost all individual steps exhibited consistent reductions in duration over time, with hepaticojejunostomy exhibiting the largest decrease (-47%; -19&#xa0;min). CUSUM analysis demonstrated that 31 cases were required to gain RPD efficiency, with pancreaticojejunostomy requiring the most cases among the individual steps (n = 53). In multivariable analysis, male patients with body mass index ≥ 30&#xa0;kg/m<sup>2</sup> and pancreatic primary tumors were associated with longer operative time, whereas more recent cases were associated with shorter operative time.</p> Conclusion <p>Total and step-specific operative times improved consistently, with variations in the number of cases required to gain efficiency for each step. These findings can inform the development of a more effective RPD learning program that focuses on each surgical step.</p>

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Defining the learning period for individual steps in robotic pancreatoduodenectomy and factors associated with operative time: analysis of initial 73 cases

  • 期刊论文

  • 发表日期：

    2025年12月22日

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  • Koichi Tomita,
  • Michael P. Kim,
  • Laura R. Prakash,
  • Jessica E. Maxwell,
  • Rebecca A. Snyder,
  • Hop S. Tran Cao,
  • Ching-Wei D. Tzeng,
  • Jeffrey E. Lee,
  • Matthew H. G. Katz,
  • Naruhiko Ikoma

摘要

Background

Robotic pancreatoduodenectomy (RPD) is a complex operation consisting of multiple surgical steps and requires significant experience to achieve efficiency. However, no studies have specifically examined the learning curve for individual steps of RPD. Therefore, we investigated the learning curve for each step of RPD in detail. The factors affecting the total operative time in RPD were also evaluated.

Methods

Data from the initial consecutive RPD cases at our institution were analyzed. Cumulative sum (CUSUM) analysis was used for total and step-specific operative time (6 resection steps and 3 reconstruction steps). Factors associated with total operative time were identified by multivariable linear regression analysis.

Results

Among 73 cases, the mean total operative time decreased from 539 min for the first 20 cases to 445 min for cases 61 to 73. Almost all individual steps exhibited consistent reductions in duration over time, with hepaticojejunostomy exhibiting the largest decrease (-47%; -19 min). CUSUM analysis demonstrated that 31 cases were required to gain RPD efficiency, with pancreaticojejunostomy requiring the most cases among the individual steps (n = 53). In multivariable analysis, male patients with body mass index ≥ 30 kg/m2 and pancreatic primary tumors were associated with longer operative time, whereas more recent cases were associated with shorter operative time.

Conclusion

Total and step-specific operative times improved consistently, with variations in the number of cases required to gain efficiency for each step. These findings can inform the development of a more effective RPD learning program that focuses on each surgical step.