Defining the Learning Curve for Team-Based Laparoscopic Pancreaticoduodenectomy

Paul J. Speicher, Daniel P. Nussbaum, Rebekah R. White, Sabino Zani, Paul J. Mosca, Dan G. Blazer, Bryan M. Clary, Theodore N. Pappas, Douglas Tyler, Alexander Perez

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

Background: The purpose of this study was to define the learning curves for laparoscopic pancreaticoduodenectomy (LPD) with and without laparoscopic reconstruction, using paired surgical teams consisting of advanced laparoscopic-trained surgeons and advanced oncologic-trained surgeons.

Methods: All patients undergoing PD without vein resection at a single institution were retrospectively analyzed. LPD was introduced by initially focusing on laparoscopic resection followed by open reconstruction (hybrid) for 18 months prior to attempting a totally LPD (TLPD) approach. Cases were compared with Chi square, Fisher’s exact test, and Kruskal–Wallis analysis of variance (ANOVA).

Results: Between March 2010 and June 2013, 140 PDs were completed at our institution, of which 56 (40 %) were attempted laparoscopically. In 31/56 procedures we planned to perform only the resection laparoscopically (hybrid), of which 7 (23 %) required premature conversion before completion of resection. Following the first 23 of these hybrid cases, a total of 25 TLPDs have been performed, of which there were no conversions to open. For all LPD, a significant reduction in operative times was identified following the first 10 patients (median 478.5 vs. 430.5 min; p = 0.01), approaching open PD levels. After approximately 50 cases, operative times and estimated blood loss were consistently lower than those for open PD.

Conclusions: In our experience of building an LPD program, the initial ten cases represent the biggest hurdle with respect to operative times. For an experienced teaching center using a staged and team-based approach, LPD appears to offer meaningful reductions in operative time and blood loss within the first 50 cases.

Original languageEnglish (US)
Pages (from-to)4014-4019
Number of pages6
JournalAnnals of Surgical Oncology
Volume21
Issue number12
DOIs
StatePublished - Oct 8 2014
Externally publishedYes

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Pancreaticoduodenectomy
Learning Curve
Operative Time
Veins
Analysis of Variance
Teaching

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Speicher, P. J., Nussbaum, D. P., White, R. R., Zani, S., Mosca, P. J., Blazer, D. G., ... Perez, A. (2014). Defining the Learning Curve for Team-Based Laparoscopic Pancreaticoduodenectomy. Annals of Surgical Oncology, 21(12), 4014-4019. https://doi.org/10.1245/s10434-014-3839-7

Defining the Learning Curve for Team-Based Laparoscopic Pancreaticoduodenectomy. / Speicher, Paul J.; Nussbaum, Daniel P.; White, Rebekah R.; Zani, Sabino; Mosca, Paul J.; Blazer, Dan G.; Clary, Bryan M.; Pappas, Theodore N.; Tyler, Douglas; Perez, Alexander.

In: Annals of Surgical Oncology, Vol. 21, No. 12, 08.10.2014, p. 4014-4019.

Research output: Contribution to journalArticle

Speicher, PJ, Nussbaum, DP, White, RR, Zani, S, Mosca, PJ, Blazer, DG, Clary, BM, Pappas, TN, Tyler, D & Perez, A 2014, 'Defining the Learning Curve for Team-Based Laparoscopic Pancreaticoduodenectomy', Annals of Surgical Oncology, vol. 21, no. 12, pp. 4014-4019. https://doi.org/10.1245/s10434-014-3839-7
Speicher PJ, Nussbaum DP, White RR, Zani S, Mosca PJ, Blazer DG et al. Defining the Learning Curve for Team-Based Laparoscopic Pancreaticoduodenectomy. Annals of Surgical Oncology. 2014 Oct 8;21(12):4014-4019. https://doi.org/10.1245/s10434-014-3839-7
Speicher, Paul J. ; Nussbaum, Daniel P. ; White, Rebekah R. ; Zani, Sabino ; Mosca, Paul J. ; Blazer, Dan G. ; Clary, Bryan M. ; Pappas, Theodore N. ; Tyler, Douglas ; Perez, Alexander. / Defining the Learning Curve for Team-Based Laparoscopic Pancreaticoduodenectomy. In: Annals of Surgical Oncology. 2014 ; Vol. 21, No. 12. pp. 4014-4019.
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abstract = "Background: The purpose of this study was to define the learning curves for laparoscopic pancreaticoduodenectomy (LPD) with and without laparoscopic reconstruction, using paired surgical teams consisting of advanced laparoscopic-trained surgeons and advanced oncologic-trained surgeons.Methods: All patients undergoing PD without vein resection at a single institution were retrospectively analyzed. LPD was introduced by initially focusing on laparoscopic resection followed by open reconstruction (hybrid) for 18 months prior to attempting a totally LPD (TLPD) approach. Cases were compared with Chi square, Fisher’s exact test, and Kruskal–Wallis analysis of variance (ANOVA).Results: Between March 2010 and June 2013, 140 PDs were completed at our institution, of which 56 (40 {\%}) were attempted laparoscopically. In 31/56 procedures we planned to perform only the resection laparoscopically (hybrid), of which 7 (23 {\%}) required premature conversion before completion of resection. Following the first 23 of these hybrid cases, a total of 25 TLPDs have been performed, of which there were no conversions to open. For all LPD, a significant reduction in operative times was identified following the first 10 patients (median 478.5 vs. 430.5 min; p = 0.01), approaching open PD levels. After approximately 50 cases, operative times and estimated blood loss were consistently lower than those for open PD.Conclusions: In our experience of building an LPD program, the initial ten cases represent the biggest hurdle with respect to operative times. For an experienced teaching center using a staged and team-based approach, LPD appears to offer meaningful reductions in operative time and blood loss within the first 50 cases.",
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AU - Mosca, Paul J.

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N2 - Background: The purpose of this study was to define the learning curves for laparoscopic pancreaticoduodenectomy (LPD) with and without laparoscopic reconstruction, using paired surgical teams consisting of advanced laparoscopic-trained surgeons and advanced oncologic-trained surgeons.Methods: All patients undergoing PD without vein resection at a single institution were retrospectively analyzed. LPD was introduced by initially focusing on laparoscopic resection followed by open reconstruction (hybrid) for 18 months prior to attempting a totally LPD (TLPD) approach. Cases were compared with Chi square, Fisher’s exact test, and Kruskal–Wallis analysis of variance (ANOVA).Results: Between March 2010 and June 2013, 140 PDs were completed at our institution, of which 56 (40 %) were attempted laparoscopically. In 31/56 procedures we planned to perform only the resection laparoscopically (hybrid), of which 7 (23 %) required premature conversion before completion of resection. Following the first 23 of these hybrid cases, a total of 25 TLPDs have been performed, of which there were no conversions to open. For all LPD, a significant reduction in operative times was identified following the first 10 patients (median 478.5 vs. 430.5 min; p = 0.01), approaching open PD levels. After approximately 50 cases, operative times and estimated blood loss were consistently lower than those for open PD.Conclusions: In our experience of building an LPD program, the initial ten cases represent the biggest hurdle with respect to operative times. For an experienced teaching center using a staged and team-based approach, LPD appears to offer meaningful reductions in operative time and blood loss within the first 50 cases.

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