The learning curve for laparoscopic pancreaticoduodenectomy by a proficient laparoscopic surgeon: A retrospective study at a single center

Abstract

Abstract Background To explore the learning curve of single center laparoscopic pancreaticoduodenectomy(LPD) and evaluate the safety and efficacy of the operation at different stages. Method The clinical data of 120 cases of laparoscopic pancreatoduodenectomy performed by the same surgeon from June 2018 to June 2022 were reviewed and analyzed. The cumulative sum (CUSUM) analysis and the best fitting curve were used to draw the learning curve for the operation time and intraoperative blood loss, respectively. The two were mutually verified, and the number of surgeries needed to accumulate across the learning curve was analyzed. The clinical data, like operation time, intraoperative blood loss, length of stay, complications and other indicators were compared at different stages of the learning curve. Result The maximum turning point of the fitting curve was found in 35 cases by the cumulative sum method of operation time, after which the learning curve could be considered to have passed. The fitting curve obtained by the cumulative sum method of intraoperative blood loss was stable in 30 cases and proficient in 60 cases, which was basically consistent with the fitting curve of operation time. Taking 35 cases as the boundary, the learning curve is divided into learning improvement stage and mastering stage. There was no statistical significance in the general data of the two stage patients (P > 0.05).Hospitalization days decreased from 19 days to 15 days (P < 0.05);Pancreatic fistula decreased from 20.0% of grade B and 8.6% of grade C to 7.1% of grade B and 3.5% of grade C (P < 0.05), and the operative time decreased from (376.9 ± 48.2) minutes to (294.4 ± 18.7) minutes (P < 0.05).Intraoperative blood loss decreased from 375ml to 241ml(P < 0.05). Conclusion 35 patients with LPD can reach the proficiency stage and the perioperative indexes can be improved.