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

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88 Scopus citations

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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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., Clary, B. M., Pappas, T. N., Tyler, D., & 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