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Background <p>Robotic pancreaticoduodenectomy (RPD) is increasingly performed, but most learning curve studies involved senior surgeons with laparoscopic pancreaticoduodenectomy (LPD) experience. Evidence is lacking for early-career surgeons transitioning directly from open surgery to robotics. This study aimed to evaluate the learning curve of RPD using dual analytic methods and to explore efficiency gains through sub-phase analysis of operative time.</p> Methods <p>We retrospectively analyzed 78 consecutive RPD performed by a single early-career surgeon (May 2023–August 2025). Learning curves were assessed using cumulative sum (CUSUM) and five-case moving average analyses of operative time. Perioperative and postoperative outcomes were compared across phases. In addition, operative time was subdivided into docking, resection, and anastomosis to evaluate phase-specific efficiency gains.</p> Results <p>CUSUM identified proficiency at case 23, and moving average showed stabilization at case 41, delineating three phases: initial learning (1–22), proficiency (23–41), and stabilization (42–78). Mean operative time decreased significantly across phases (523.6 → 309.3&#xa0;min; <i>p</i> &lt; 0.001). Clinically relevant pancreatic fistula declined from 31.8 to 5.4% (<i>p</i> = 0.012). Conversion to open surgery was 3.8%. Sub-phase analysis demonstrated that most reductions were attributable to shorter resection and docking times, while anastomosis time remained stable. Oncologic adequacy was preserved (mean lymph nodes 18.6, R0 resection 97.4%). No 90-day mortality occurred.</p> Conclusion <p>In this single-surgeon series, operative proficiency appeared after approximately 23 cases and stabilized after 41 cases. Dual analytic methods revealed complementary insights into the learning curve, and sub-phase analysis highlighted that efficiency gains were primarily achieved in resection and docking. RPD may represent a feasible training pathway for early-career surgeons in structured high-volume environments with appropriate mentorship.</p>

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Learning curve of totally robotic pancreaticoduodenectomy in early-career surgeons: a dual analysis using CUSUM and moving average

  • 期刊论文

  • 发表日期：

    2026年5月28日

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  • Boram Lee,
  • Ho-Seong Han,
  • Yoo-Seok Yoon,
  • Jai Young Cho,
  • Hae Won Lee,
  • Yeshong Park,
  • Seung Yeon Lim,
  • Hyelim Joo

摘要

Background

Robotic pancreaticoduodenectomy (RPD) is increasingly performed, but most learning curve studies involved senior surgeons with laparoscopic pancreaticoduodenectomy (LPD) experience. Evidence is lacking for early-career surgeons transitioning directly from open surgery to robotics. This study aimed to evaluate the learning curve of RPD using dual analytic methods and to explore efficiency gains through sub-phase analysis of operative time.

Methods

We retrospectively analyzed 78 consecutive RPD performed by a single early-career surgeon (May 2023–August 2025). Learning curves were assessed using cumulative sum (CUSUM) and five-case moving average analyses of operative time. Perioperative and postoperative outcomes were compared across phases. In addition, operative time was subdivided into docking, resection, and anastomosis to evaluate phase-specific efficiency gains.

Results

CUSUM identified proficiency at case 23, and moving average showed stabilization at case 41, delineating three phases: initial learning (1–22), proficiency (23–41), and stabilization (42–78). Mean operative time decreased significantly across phases (523.6 → 309.3 min; p < 0.001). Clinically relevant pancreatic fistula declined from 31.8 to 5.4% (p = 0.012). Conversion to open surgery was 3.8%. Sub-phase analysis demonstrated that most reductions were attributable to shorter resection and docking times, while anastomosis time remained stable. Oncologic adequacy was preserved (mean lymph nodes 18.6, R0 resection 97.4%). No 90-day mortality occurred.

Conclusion

In this single-surgeon series, operative proficiency appeared after approximately 23 cases and stabilized after 41 cases. Dual analytic methods revealed complementary insights into the learning curve, and sub-phase analysis highlighted that efficiency gains were primarily achieved in resection and docking. RPD may represent a feasible training pathway for early-career surgeons in structured high-volume environments with appropriate mentorship.