ePoster
Presentation Description
Institution: Royal North Shore Hospital - NSW, Australia
Background : The safe implementation of robotic pancreatoduodenectomy (RPD) requires significant healthcare resourcing. While individual technical learning is frequently discussed, the learning curves of hospitals/programs remain poorly defined, complicating credentialing and program development. The aim was to characterize institutional learning curves and attempt to define objective center-volume thresholds for system-level safety and proficiency in RPD.
Methods: A systematic search of PubMed, Embase, and Scopus was conducted for articles published from January 1, 2005, to January 1, 2025. Studies reporting interval-level adoption data for consecutive RPD series utilizing recognized statistical phase analyses were included. Data were extracted in aggregated institutional case-volume bands following PRISMA guidelines. Outcomes within the first 150 center cases were modelled using weighted generalized linear models and restricted cubic splines. Breakpoints were defined via segmented regression and validated via 1000-iteration bootstrap resampling. Exact case-number thresholds for programmatic safety competency (Knot 1) and institutional proficiency (Knot 2) across intraoperative and postoperative outcomes.
Results: Twenty-six studies encompassing 7,377 RPD procedures met inclusion criteria. Significant non-linear institutional learning curves were observed for operative time, blood loss, conversion, and major morbidity (all P < .05). Programmatic safety competency was achieved between 45-65 institutional cases, while system proficiency required 80 to 100 cases. Both conversion-to-open (risk ratio [RR], 0.40; 95% CI, 0.25-0.64) and major morbidity (RR, 0.73; 95% CI, 0.56-0.94) significantly improved with center experience. Conversely, delayed gastric emptying and readmission demonstrated U-shaped trajectories, likely reflecting the escalating oncologic complexity assumed by maturing programs. Subgroup analysis revealed that venous resection significantly delayed competency and prolonged progression to proficiency (interaction P < .001).
Conclusions and Relevance: In this systematic review and modelling analysis, RPD implementation functioned as a non-linear process reflecting growing center experience, rather than isolated technical skill. Foundational institutional safety is achieved by approximately 45 to 65 center cases, and system-level proficiency requires 80 to 100 cases. These evidence-based benchmarks should be considered to guide credentialing, multidisciplinary team training, and safe institutional adoption frameworks.
Presenters
Authors
Authors
Dr Krishna Kotecha - , Prof Anubhav Mittal - , Prof Jaswinder Samra - , Prof Handan Wand -
