Mitigation of the Robotic Pancreaticoduodenectomy Learning Curve through comprehensive training

Abstract Background The utilization of robotic surgery for pancreaticoduodenectomy (PD) is increasing. There is an associated lag in achieving competency for this complex operation, resulting in a learning curve. We hypothesize that the reported learning curve can be mitigated through a comprehensive graduated training protocol. Methods Prior to robotic PD program implementation, three surgeons and operating room staff at The Ohio State University underwent comprehensive PD-specific robotic training. All patients who underwent an open or robotic PD between 2015 and 2019 were identified. The learning curve for operative time and surgical failure (defined as conversion to open, blood transfusion, or Clavien-Dindo complication grade ≥3) was analyzed using a risk adjusted cumulative summation technique. Robotic and open patients were propensity score-matched 1:2 on pre-operative clinicopathologic risk factors and peri-operative outcomes were compared. Results 237 patients who underwent an open (n = 197, 83.1%) or robotic (n = 40, 16.9%) PD during the study period were identified. After 10 cases, operative time plateaued to a mean of 468.3 ± 96.3 min for robotic PD versus a mean of 332.5 ± 103.9 min for open PD over the study period (P   0.05). Conclusion Completion of a comprehensive procedure-specific robotic training protocol for PD mitigated the learning curve for this operative approach by shifting the curve into the training/simulation phase rather than the live operating phase. Furthermore, perioperative outcomes between patients undergoing open and robotic PD were similar. These data hold important implications for the future training and accreditation of surgeons embarking on robotic PD.