Robotic-assisted pancreaticoduodenectomy: Technique description and performance evaluation after 60 cases

Purpose: Robotic pancreaticoduodenectomy (RPD) remains one of the most challenging abdominal operations. During the implementation of new surgical technologies, safety and efficacy outcomes must be rigorously monitored and the learning curve clearly identified. Materials and Methods: The authors investigated their experience during the adoption of RPD, analyzing the outcomes of our first 60 consecutive cases, divided into group A (1 to 30) and group B (31 to 60). The cumulative sum (CUSUM) analysis was used to define the learning curve. Results: The authors observed a reduction in operative time (125 min) and estimated blood loss (185 mL) between the firsts 1 to 30 and the latest 30 cases. The overall rate of complications showed the tendency to decrease during the experience (46.7% vs. 23.3%, P = 0.02), conversely, severe complications and the rate of clinically relevant postoperative pancreatic fistula did not show a significant reduction in the incidence (P = 0.37 and P = 0.67, respectively). The mean number of lymph nodes harvested improved significantly after 30 cases (P = 0.004). Conclusion: Surgical performance improved significantly after the first 30 cases.