Total laparoscopic pancreaticoduodenectomy in patients with periampullary tumors: a learning curve analysis

Munseok Choi, Ho Kyoung Hwang, Woo Jung Lee, Chang Moo Kang

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)


Background: With continued technical advances in surgical instruments and growing expertise, many surgeons have safely performed laparoscopic pylorus-preserving pancreaticoduodenectomies (LPDs) with good results, and the laparoscopic approach is being performed more frequently. However, this complex procedure requires a relatively long training period to ensure technical competence. The present study aimed to analyze the learning curve for LPD. Methods: From September 2012 to May 2019, LPDs were performed for 171 patients at the Yonsei University Severance Hospital by a single surgeon. We retrospectively analyzed the demographic and surgical outcomes. The learning curve for LPD was evaluated using both the cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) methods. All variables among the learning curve phases were compared. Results: Based on the CUSUM and the RA-CUSUM analyses, the learning curve for LPD was grouped into three phases: phase I was the initial learning period (cases 1–40), phase II represented the technical competence period (cases 41–100), and phase III was regarded as the challenging period (cases 101–171). Conclusions: According to the learning curve analysis, 40 cases are required to achieve technical competence in LPD and 100 cases are required to address highly challenging cases.

Original languageEnglish
Pages (from-to)2636-2644
Number of pages9
JournalSurgical endoscopy
Issue number6
Publication statusPublished - 2021 Jun

Bibliographical note

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© 2020, Springer Science+Business Media, LLC, part of Springer Nature.

All Science Journal Classification (ASJC) codes

  • Surgery


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