First assistant experience in total laparoscopic pancreaticoduodenectomy: accelerating the learning curve for an operator

OBJECTIVE: Compare and analyze clinical data of total laparoscopic pancreaticoduodenectomy (TLPD) cases for surgeons with / without first assistant experience (FAE) in TLPD. Probe influence of FAE in TLPD on the learning curve for an operator. METHODS: The clinical data of 239 patients, that underwent TLPD performed by two surgeons between January 2017 and January 2022) in our department, were consecutively collected and divided into two groups (A and B). Group A cases were operated by Surgeon A, with FAE of 57 TLPDs in our department prior to initial TLPD as an operator. Group B cases were operated by Surgeon B with no FAE of TLPD. Cumulative sum (CUSUM) method developed learning curves. Clinical data and both surgeons’ learning curves were statistically compared between both groups. RESULTS: Between both groups, no statistically significant variations were observed for pre-operative health conditions. Reduced surgical duration, blood loss and transfusion volume during surgery, together with reductions in major post–operative complication rates and reduced hospital/ICU stays were identified within Group A, having statistically significant variations. The technical plateau phases of the learning curves were approximately 25–41 cases and 35–51 cases, for Surgeon A and Surgeon B, respectively. CONCLUSION: FAE in TLPD can accelerate the learning curve of TLPD for an operator, with safer surgical procedures and enhanced post–operative recovery.