Procedure-specific Training for Robot-assisted Distal Pancreatectomy

Sjors Klompmaker, Walderik J. van der Vliet, Stijn J. Thoolen, Ana Sofia Ore, Koen Verkoulen, Monica Solis-Velasco, Elena G. Canacari, Jonathan B. Kruskal, Khalid O. Khwaja, Jennifer F. Tseng, Mark P. Callery, Tara S. Kent, A. James Moser*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objective: To train practicing surgeons in robot-assisted distal pancreatectomy (RADP) and assess the impact on 5 domains of healthcare quality.

Background: RADP may reduce the treatment burden compared with open distal pancreatectomy (ODP), but studies on institutional training and implementation programs are scarce.

Methods: A retrospective, single-center, cohort study evaluating surgical performance during a procedure-specific training program for RADP (January 2006 to September 2017). Baseline and unadjusted outcomes were compared ''before training'' (ODP only; June 2012). Exclusion criteria were neoadjuvant therapy, vascular- and unrelated organ resection. Run charts evaluated index length of stay (LOS) and 90-day comprehensive complication index. Cumulative sum charts of operating time (OT) assessed institutional learning. Adjusted outcomes after RADP versus ODP were compared using a secondary propensityscore-matched (1:1) analysis to determine clinical efficacy.

Results: After screening, 237 patients were included in the before-training (133 ODP) and after-training (24 ODP, 80 RADP) groups. After initiation of training, mean perioperative blood loss decreased (-255 mL, P 0.05). Over time, there were nonrandom (P < 0.05) downward shifts in LOS, while comprehensive complication index was unaffected. We observed 3 learning curve phases in OT: accumulation (65 cases). Propensity-score-matching confirmed reductions in index and 90-day LOS and blood loss with similar morbidity between RADP and ODP.

Conclusion: Supervised procedure-specific training enabled successful implementation of RADP by practicing surgeons with immediate improvements in length of stay, without adverse effects on safety.

Original languageEnglish
Pages (from-to)E18-E27
Number of pages10
JournalAnnals of Surgery
Issue number1
Publication statusPublished - Jul 2021


  • cohort study
  • comparative effectiveness
  • distal pancreatectomy
  • laparoscopic surgery
  • pancreas
  • pancreatic disease
  • pancreatic tail
  • robotic surgery
  • single-center
  • surgery
  • surgical training
  • training program

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