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Journal of Gastrointestinal Surgery

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01-05-2016 | Original Article

Learning Curve for Laparoscopic Pancreaticoduodenectomy: a CUSUM Analysis

Authors: Mingjun Wang, Lingwei Meng, Yunqiang Cai, Yongbin Li, Xin Wang, Zhaoda Zhang, Bing Peng

Published in: Journal of Gastrointestinal Surgery | Issue 5/2016

Abstract

Background

Laparoscopic pancreaticoduodenectomy (LPD), an advanced minimally invasive technique, has demonstrated advantages to open pancreaticoduodenectomy (OPD). However, this complex procedure requires a relatively long training period to ensure technical proficiency. This study was therefore designed to analyze the learning curve for LPD.

Methods

From October 2010 to September 2015, 63 standard pancreaticoduodenectomy procedures were to be performed laparoscopically by a single surgeon at the Department of Pancreatic Surgery, West China Hospital, Sichuan University, China. After applying the inclusion and exclusion criteria, a total of 57 patients were included in the study. Data for all the patients, including preoperative, intraoperative, and postoperative variables, were prospectively collected and analyzed. The learning curve for LPD was evaluated using both cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) methods. All of the variables among the learning curve phases were compared.

Results

Based on the CUSUM and the RA-CUSUM analyses, the learning curve for LPD was grouped into three phases: phase I was the initial learning period (cases 1–11), phase II represented the technical competence period (cases 12–38), and phase III was regarded as the challenging period (cases 39–57). The operative time, intraoperative blood loss, and postoperative ICU demand significantly decreased with the learning curve. More lymph nodes were collected after the initial learning period. There were no significant differences in terms of postoperative complications or the 30-day mortality among the three phases. More challenging cases were encountered in phase III.

Conclusions

According to this study, the learning curve for LPD consisted of three phases. Conservatively, to attain technical competence for performing LPD, a minimum of 40 cases are required for laparoscopic surgeons with a degree of laparoscopic experience.

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Title: Learning Curve for Laparoscopic Pancreaticoduodenectomy: a CUSUM Analysis
Authors: Mingjun Wang
Lingwei Meng
Yunqiang Cai
Yongbin Li
Xin Wang
Zhaoda Zhang
Bing Peng
Publication date: 01-05-2016
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 5/2016
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-016-3105-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Learning Curve for Laparoscopic Pancreaticoduodenectomy: a CUSUM Analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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