A novel laparoscopic pancreaticoduodenal training model: optimization of the learning curve and simplification of postoperative complications

Purpose: Laparoscopic pancreaticoduodenectomy requires a long learning curve. A preoperative training system was established to optimize the surgeons' learning curve and reduce the incidence rate of complications at the beginning of the curve. Methods: The laparoscopic pancreaticojejunostomy model, and choledochojejunostomy and gastrojejunostomy training systems were developed, and corresponding evaluation systems were also defined. Surgeons B and C performed laparoscopic pancreaticoduodenectomy after completing training session. Surgical outcomes, postoperative complications and their learning curves were analyzed. Results: Patients operated by surgeons B and C experienced shorter operative durations following training session than those in nontrained group (called A) (P<0.001). B and C began entering the inflection point at the 26th and 20th case in learning curve, respectively. The incidence of postoperative pancreatic fistula in group B was 3.3%, significantly lower than 13.1% in group A (P=0.047). Patients in group B showed significantly lower incidence of biliary-enteric anastomosis leakage (0% vs. 8.2%, P=0.029) and Clavien-Dindo classification greater than or equal to 3 (3.3% vs. 14.8%, P=0.027) compared with those in group A. The incidence of surgical site infection in groups B (3.3%, P=0.004) and C (4.9%, P=0.012) was significantly lower than that in group A (19.7%). Moreover, the length of postoperative hospital stay was significantly shorter in groups B (12.5 +/- 5.9 days, P=0.002) and C (13.7 +/- 6.5 days, P=0.002) compared with group A (16.7 +/- 8.5 days). Conclusions: The laparoscopic pancreaticojejunostomy training model and evaluation system can shorten the operative duration, lower the risk of postoperative complications, and shorten the length of hospital stay.