title: The Learning Curve in Robotic Pancreaticoduodenectomy.
abstract: OBJECTIVE
  Few data are available on the learning curve (LC) in robot-assisted pancreaticoduodenectomy (RAPD) and no study specifically addresses the LC of a single surgeon.
  
  
  METHODS
  The LC of a single surgeon in RAPD was determined using the cumulative sum method, based on operative time (OT). Data were extracted from a prospectively maintained database and analyzed retrospectively considering all events occurring within 90 days of index operation.
  
  
  RESULTS
  Seventy RAPD were analyzed. One operation was converted to open surgery (1.4%). One patient died within 30 days (1.4%) and one within 90 days (2.8%). Postoperative complications occurred in 53 patients (75.7%) and exceeded Clavien-Dindo grade IIIb in 7 patients (10%). OT dropped after 33 operations from a mean of 564 ± 101.7 min to a mean of 484.1 ± 77.9 min (p = 0.0005) and was associated to reduced incidence of delayed gastric emptying (72.7 vs. 48.7%; p = 0.039). The rate of hospital readmission improved after 40 operations from 20.0 (8 of 40) to 3.3% (1 of 30) (p = 0.04).
  
  
  CONCLUSIONS
  RAPD was safely feasible in selected patients. OT dropped after the first 33 operations and was associated with reduced rate of delayed gastric emptying. Readmission rate improved after 40 operations.
authors.affiliation: Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Napoli
authors.forename: E F
authors.initials: EF
authors.lastname: Kauffmann
authors.forename: M
authors.initials: M
authors.lastname: Palmeri
authors.forename: M
authors.initials: M
authors.lastname: Miccoli
authors.forename: F
authors.initials: F
authors.lastname: Costa
authors.forename: F
authors.initials: F
authors.lastname: Vistoli
authors.forename: G
authors.initials: G
authors.lastname: Amorese
authors.forename: Ugo
authors.initials: U
authors.lastname: Boggi
mesh_terms: D000368:Aged; D061887:Conversion to Open Surgery; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects