LAUSR

BACKGROUND Learning curves of laparoscopic distal pancreatectomy (LDP) are mostly based on 'self-taught' surgeons who acquired sufficient proficiency largely through self-teaching. No learning curves have been investigated for 'trained' surgeons who received training and built on the experience of the 'self-taught' surgeons. This study compared the learning curves and outcome of LDP between 'self-taught' and 'trained' surgeons in terms of feasibility and proficiency using short term outcomes. MATERIALS AND METHODS Data of consecutive patients with benign or malignant disease of the left pancreas who underwent LDP by 4 'self-taught' and 4 'trained' surgeons between 1997-2019 were collected, starting from the first patient operated by a contributing surgeon. Risk-adjusted cumulative sum (RA-CUSUM) analyses were performed to determine phase-1 feasibility (operative time) and phase-2 proficiency (major complications) learning curves. Outcomes were compared based on the inflection points of the learning curves. RESULTS The inflection points for the feasibility and proficiency learning curves were 24 and 36 procedures for 'trained' surgeons compared to 64 and 85 procedures for 'self-taught' surgeons, respectively. In 'trained' surgeons, operative time reduced after completion of the learning curves (230.5 to 203 minutes, P=0.028). In 'self-taught' surgeons, operative time (240 to 195 minutes, P=<0.001), major complications (20.6 to 7.8%, P=0.008) and length of hospital stay (9 to 5 d P=<0.001) reduced after completion of the learning curves. CONCLUSION This retrospective international cohort study showed that the feasibility and proficiency learning curves for LDP of 'trained' surgeons were at least halved as compared to 'self-taught' surgeons.