title: Laparoscopic Distal Pancreatectomy: Learning Curve and Experience in a Tertiary Center.
abstract: BACKGROUND
  Although laparoscopic distal pancreatectomy (LDP) is gradually recognized as a safe and effective alternative to open distal pancreatectomy (ODP), it is not yet widely accepted.
  
  
  OBJECTIVE
  We describe our experience, with emphasis on the learning curve of LDP.
  
  
  METHODS
  Patients who underwent distal pancreatectomy (DP) between January 2011 and August 2014 were included. Operative and postoperative parameters, as well as pathology reports were evaluated.
  
  
  RESULTS
  Thirty-nine and 41 patients underwent LDP and ODP, respectively. The mean age and gender distribution were comparable between groups. In six patients (15.4%), a conversion to open surgery was indicated. Operating time and intraoperative blood transfusion rates were comparable between groups. One patient of the LDP group died postoperatively. Postoperative complications were comparable with similar Dindo-Clavien (DC) score. Length of stay (LOS) was shorter following LDP (8.15 ± 4.68 versus 11.3 ± 6.3 days, P = .014). Patients selected to have LDP had larger lesions compared to those who underwent ODP (4.59 ± 4.23 versus 3 ± 2.52 cm, respectively, P = .048). R0 resection rates between the groups were comparable (92.3% in LDP versus 97.5% in ODP) as well as lymph node (LN) harvest (6.4 ± 6.4 LN in LDP versus 7.6 ± 6.6 LN in ODP). Following the 17th patient, LDP operative time decreased by more than 35 minutes, no conversions were done, no blood transfusion was needed, and the LOS was shortened by over 2 days.
  
  
  CONCLUSIONS
  Short learning curve, shorter LOS, and satisfactory short-term oncological outcome place LDP as an attractive alternative for selected patients requiring DP.
authors.affiliation: Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv, Israel .
authors.forename: Ido
authors.initials: I
authors.lastname: Nachmany
authors.affiliation: Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv, Israel .
authors.forename: Niv
authors.initials: N
authors.lastname: Pencovich
authors.affiliation: Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv, Israel .
authors.forename: Amir
authors.initials: A
authors.lastname: Ben-Yehuda
authors.affiliation: Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv, Israel .
authors.forename: Guy
authors.initials: G
authors.lastname: Lahat
authors.affiliation: Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv, Israel .
authors.forename: Richard
authors.initials: R
authors.lastname: Nakache
authors.affiliation: Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv, Israel .
authors.forename: Yaacov
authors.initials: Y
authors.lastname: Goykhman
authors.affiliation: Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv, Israel .
authors.forename: Nir
authors.initials: N
authors.lastname: Lubezky
authors.affiliation: Division of General Surgery, Department of General Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv, Israel .
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Klausner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D059032:Learning Curve; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult