title: Minimally Invasive Distal Pancreatectomy: A Single-Center Analysis of Outcome With Experience and Systematic Review of the Literature.
abstract: BACKGROUND
  The aim of this study is to analyze the learning curve for laparoscopic distal pancreatectomy (LDP) in our series and review the literature on learning curves for LDP and robotic distal pancreatectomy (RDP).
  
  
  METHODS
  Learning curve analysis was performed by split group and cumulative sum (CUSUM) analysis of blood loss, operative time, and length of stay. The systematic review identified studies analyzing changes in outcome with experience.
  
  
  RESULTS
  A total of 25 resections were performed. CUSUM analysis of operative time found learning curves of 10 cases for LDP and splenectomy and 11 for LDP with splenic preservation. CUSUM analysis of blood loss showed approximately 6 cases. In the literature, values of 10 cases of LDP and approximately 7 RDP were found.
  
  
  CONCLUSIONS
  Low numbers of LDP are required to reach proficiency in the hands of expert laparoscopic surgeons. Our results correspond with numbers quoted in the literature.
authors.affiliation: *Pennine Acute Hospitals NHS Trust, Oldham †Department of Surgery, Salford Royal Hospital, Salford, Manchester, UK.
authors.forename: Jenifer
authors.initials: J
authors.lastname: Barrie
authors.forename: Basil J
authors.initials: BJ
authors.lastname: Ammori
mesh_terms: D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D059032:Learning Curve; D061646:Operative Time; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D012371:Robotics; D016896:Treatment Outcome