OBJECTIVE The aim of this study was to evaluate the different phases of the learning curve for robotic distal pancreatectomy (RDP) in international expert centers. SUMMARY BACKGROUND DATA RDP is an emerging minimally invasive approach; however, only limited, mostly single center data are available on its safe implementation, including the learning curve. METHODS Consecutive patients undergoing elective RDP from 16 expert centers across three continents were included to assess the learning curve. Based on the first 100 RDPs at each center, three cutoffs were used to define the learning curve: operative time for competency, major complications (Clavien-Dindo grade ≥III) for proficiency, and textbook outcome for mastery. Clinical outcomes before and after the cutoffs were compared. RESULTS The learning curve analysis was conducted on 1109 of 2403 RDPs. Competency, proficiency, and mastery, respectively, were reached after 46, 63, and 73 RDP procedures. After competency, operative time decreased from 245 to 235 minutes (P=0.002). Attaining proficiency was reflected by a reduction in the rate of major complications from 20% to 15% (P=0.012), and mastery was associated with a higher proportion of patients with textbook outcome (71% vs. 63%; P=0.028). The postoperative pancreatic fistula rate remained stable along the learning curve, ranging between 18.5% and 21.5%. Previous laparoscopic experience accelerated the learning process by virtue of reduced operative time and an earlier decrease in major complications. CONCLUSION Competency, proficiency, and mastery for RDP were reached after 46, 63, and 73 procedures, respectively, at international expert centers. The findings highlight that the learning curves for intraoperative parameters are completed earlier; however, extensive experience is needed to master RDP.

中文翻译：

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能力、熟练程度和掌握度：16 个国际专家中心的机器人远端胰腺切除术学习曲线。


目的 本研究的目的是评估国际专家中心机器人远端胰腺切除术 （RDP） 学习曲线的不同阶段。总结 背景数据 RDP 是一种新兴的微创方法;但是，只有有限的（主要是单中心）数据可用于其安全实施，包括学习曲线。方法 纳入来自三大洲 16 个专家中心接受择期 RDP 的连续患者，以评估学习曲线。基于每个中心的前 100 个 RDP，使用三个临界值来定义学习曲线：能力的手术时间、熟练度的主要并发症（Clavien-Dindo ≥III 级）和掌握的教科书结果。比较临界值前后的临床结局。结果 对 2403 个 RDP 中的 1109 个进行了学习曲线分析，在 46、63 和 73 个 RDP 程序后分别达到能力、熟练度和掌握度。能力后，手术时间从 245 分钟减少到 235 分钟 （P=0.002）。达到熟练程度反映为主要并发症的发生率从 20% 降低到 15% （P=0.012），并且掌握与具有教科书结果的患者比例较高相关 （71% vs. 63%;P=0.028）。术后胰瘘发生率沿学习曲线保持稳定，范围在 18.5% 至 21.5% 之间。以前的腹腔镜经验通过减少手术时间和早期减少主要并发症加速了学习过程。结论 在国际专家中心分别经过 46 、 63 和 73 次程序后，达到 RDP 的能力、熟练程度和掌握程度。 研究结果强调，术中参数的学习曲线完成得更早;但是，掌握 RDP 需要丰富的经验。