A novel laparoscopic pancreaticoduodenal training model: optimization of the learning curve and simplification of postoperative complications

Abstract

Purpose: Laparoscopic pancreaticoduodenectomy requires a long learning curve. A preoperative training system was established to optimize the surgeons’ learning curve and reduce the incidence rate of complications at the beginning of the curve. Methods: The laparoscopic pancreaticojejunostomy model, and choledochojejunostomy and gastrojejunostomy training systems were developed, and corresponding evaluation systems were also defined. Surgeons B and C performed laparoscopic pancreaticoduodenectomy after completing training session. Surgical outcomes, postoperative complications and and their learning curves were analyzed. Results: Patients operated by surgeons B and C experienced shorter operative durations following training session than those in nontrained group (called A) (P<0.001). B and C began entering the inflection point at the 26th and 20th case in learning curve, respectively. The incidence of postoperative pancreatic fistula in group B was 3.3%, significantly lower than 13.1% in group A (P=0.047). Patients in group B showed significantly lower incidence of biliary-enteric anastomosis leakage (0%vs. 8.2%,P=0.029) and Clavien–Dindo classification ≥3 (3.3%vs. 14.8%,P=0.027) compared with those in group A. The incidence of surgical site infection in groups B (3.3%,P=0.004) and C (4.9%,P=0.012) was significantly lower than that in group A (19.7%). Moreover, the length of postoperative hospital stay was significantly shorter in groups B (12.5±5.9 d, P=0.002) and C (13.7±6.5 d, P=0.002) compared with group A (16.7±8.5 d). Conclusions: The laparoscopic pancreaticojejunostomy training model and evaluation system can shorten the operative duration, lower the risk of postoperative complications, and shorten the length of hospital stay.