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Analysis of the Impact of the Learning Curve on the Safety Outcome of the Totally Robotic-Assisted Biliopancreatic Diversion with Duodenal Switch: a Single-Institution Observational Study

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Abstract

Introduction

Totally robotic-assisted biliopancreatic diversion with duodenal switch (BPD/DS) learning curve has been described to be longer at approximately 50 cases, at which point operative time and complications rate decrease and tend to stabilize. This study aimed to form an analysis of the impact of the learning curve on the safety outcomes of the totally robotic-assisted BPD/DS.

Methods

A retrospective review of patients who underwent primary totally robotic-assisted BPD/DS by one of our certified bariatric and metabolic surgeon member of our institution was performed. The patients were classified into two groups, the learning stage group (first 50 cases) and the mastery stage group. Differences in operative time in minutes and postoperative outcomes were analyzed.

Results

Two hundred seventy-six patients were included. The operative time and the postoperative length of stay were significantly higher in the learning stage group (173.8 ± 35.8 min vs. 139.2 ± 30.2 min, p= 0.0001; 3.4 ± 1.4 days vs. 2.6 ± 0.9 days, p= 0.0002). The overall leakage rate was significantly higher in the learning stage group (8% vs. 0.4%, p= 0.0001). The global rate of complications for the learning stage group was 14%, and for the mastery stage group was 6.6% (p= 0.08).

Conclusions

After the first 50 cases, the operative time, the length of stay, and the overall rate of complications decreased, being especially significant the decrease in the duodeno-ileal anastomosis leakage rate after reaching the learning curve.

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Author information

Authors and Affiliations

  1. Weight Loss and Bariatric Surgery Institute, Orlando Health, Orlando, USA

    Andre Teixeira, Muhammad Jawad, Muhammad Ghanem & Romulo Lind

  2. Corporate Director Robotic Surgery Program, Orlando Health, Orlando, USA

    Alexis Sánchez

  3. Research Fellow, Robotic Surgery Program, Orlando Health, Orlando, USA

    Carlos Petrola

  4. General and Digestive Surgery Department, Hospital Universitari Joan XXIII, Carrer Dr. Mallafre Guasch 4, ZIP: 43005, Tarragona, Spain

    Carlos Petrola

Authors
  1. Andre Teixeira
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  2. Muhammad Jawad
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  3. Muhammad Ghanem
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  4. Alexis Sánchez
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  5. Carlos Petrola
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  6. Romulo Lind
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Contributions

All authors contributed substantially to the design, analysis, and interpretation of the present study. Likewise, all the authors gave their final approval of the version that is sent for publication.

Corresponding author

Correspondence to Carlos Petrola.

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Ethical Approval

For this type of study, formal consent is not required.

Conflict of Interest

Author Andre Teixeira and Author Alexis Sánchez have been proctors of Robotic Surgery and have received honoraria from Intuitive Surgical Inc. The remaining authors have no conflicts of interest or financial ties to disclose.

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Key points

- Totally Robotic-Assisted BPD/DS learning curve has been set at 50 cases.

- After the first 50 cases, surgical time and hospitalization time decrease.

- The overall complications rate and specially the duodeno-ileal anastomosis leakage rate decreases after the first 50 cases.

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Teixeira, A., Jawad, M., Ghanem, M. et al. Analysis of the Impact of the Learning Curve on the Safety Outcome of the Totally Robotic-Assisted Biliopancreatic Diversion with Duodenal Switch: a Single-Institution Observational Study. OBES SURG 33, 2742–2748 (2023). https://doi.org/10.1007/s11695-023-06719-8

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