logo SBA

ETD

Archivio digitale delle tesi discusse presso l’Università di Pisa

Tesi etd-10232023-122616


Tipo di tesi
Tesi di specializzazione (5 anni)
Autore
GINESINI, MICHAEL
URN
etd-10232023-122616
Titolo
Robot assisted pancreatoduodenectomy (r-PD): learning curve analysis of a high-volume center. The Pisa experience.
Dipartimento
PATOLOGIA CHIRURGICA, MEDICA, MOLECOLARE E DELL'AREA CRITICA
Corso di studi
CHIRURGIA GENERALE
Relatori
relatore Prof. Boggi, Ugo
Parole chiave
  • minimally invasive pancreatic surgery
  • pancreas
  • pancreatic surgery
  • robot assisted pancreatic surgery
  • robot assisted surgery
Data inizio appello
07/11/2023
Consultabilità
Non consultabile
Data di rilascio
07/11/2093
Riassunto
Introduction: to analyze the learning curve of robot-assisted pancreatoduodenectomy (r-PD) and the effects of training on short-term prognosis.
Method: the learning curve of r-PD performed by a single highly experienced surgeon in a high-volume center was determined using the cumulative sum method, based on operative time (OT) and length of hospitalization (LOH). Data were extracted from a prospectively maintained database and analyzed retrospectively considering all events occurring within 90 days of index operation. The outcomes were studied into three different groups based on three phases of CUSUM-LOH.
Results: We analyzed 298 r-PD. A three phases model was observed for both outcomes. Considering OT there was a drop-down after 37 procedures (median OT 550 min. vs. 505 min., p=0.0017) and an increase after 233 procedures (median OT 505 min. vs. 547 min., p=0.0001). Considering LOH, the plateau was achieved after 130 procedures and a drop-down after 183 procedures (median LOH: 18 days vs. 15 days, p= 0.02) without differences in OT and conversion rate; conversely the vein resection rate increased (6.9% vs. 7.6% vs. 14.8%, p=0.04). The three groups didn’t shown difference considering severe post-operative complications and mortality rate, clinically-relevant POPF rate and failure-to-rescue rate.
Conclusion: OT is initially reduced (37 procedures) and subsequently increased (233 procedures) due to the higher procedure’s difficulty (represented by the vascular resections rate). Proficiency regarding post-operative outcomes (LOH) was obtained later (183 procedures). Despite more challenging procedures the mastery by the surgeon and the team allows complications rate to remain unchanged and shorten the LOH.
File