Learning curve length estimated for minimally invasive distal pancreatectomy

The learning curve length for minimally invasive distal pancreatectomy (MIDP) is estimated at 85 procedures for the primary textbook outcome (TBO), according to a study published online June 28 in JAMA Surgery.

Sanne Lof, M.D., Ph.D., from the University of Amsterdam, and colleagues examined the length of pooled learning curves for MIDP in experienced centers in a multicenter, retrospective cohort study including MIDP procedures performed from Jan. 1, 2006, through June 30, 2019, in 26 European centers from eight countries. The learning curve was assessed for the primary TBO, a composite measure reflecting optimal outcome and surgical mastery. For the secondary outcomes of operation time, intraoperative blood loss, conversion to open rate, and postoperative pancreatic fistula grade B/C, the learning curve was also assessed. The learning curve analysis was conducted on 2,041 procedures.

The researchers observed an increase and eventually a break point for TBO at 85 procedures, with the TBO rate plateauing at 70%. The estimated learning-associated loss of TBO rate was 3.3%. A break point was estimated at 40 procedures for conversion, at 56 procedures for operation time, and at 71 procedures for intraoperative blood loss. No break point could be estimated for postoperative pancreatic fistula.

"Although MIDP is considered a valuable alternative to open distal pancreatectomy, our findings suggest that it may take extensive experience to master the learning curve," the authors write.

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