{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T05:31:30Z","timestamp":1783056690872,"version":"3.54.6"},"reference-count":35,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T00:00:00Z","timestamp":1740355200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Gastroent Surgery"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The granular methods by which centers can safely implement and effectively expand robotic distal pancreatectomy (RDP), including those related to appropriate patient selection during the learning curve period, remain unclear. This study aimed to verify that our strategic robotic surgical oncology program effectively implemented RDP as standard practice and to identify factors associated with prolonged operation time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>We performed a detailed analysis of the intraoperative and short\u2010term outcomes of consecutive patients (October 2018\u2013September 2023) undergoing RDP at our center, beginning with the first patient in our program. Operation time was analyzed using a cumulative sum chart (CUSUM), and factors associated with prolonged operation time were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Throughout the study period, five surgeons performed RDP for 117 patients. The CUSUM analysis indicated our center required 18 cases to overcome the initial learning phase and 43 additional cases to become proficient. In contrast, when comparing short\u2010term outcomes across the three observation periods, there were no significant changes in the incidence of ACCORDION grade \u22653 pancreatic fistulas (<jats:italic>p<\/jats:italic>\u2009=\u20090.684), or readmission rates (<jats:italic>p<\/jats:italic>\u2009=\u20090.457). A multivariable analysis revealed BMI \u226530 in male, the presence of pancreatitis or fibrosis, and the performance of concomitant procedures were associated with extended operation times, while BMI \u226530 in female was not.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although an institutional learning curve was observed, our program enabled the safe implementation of RDP and successfully expanded the number of primary operating surgeons while maintaining stable short\u2010term outcomes. The absence of an impact of high BMI on operation time in female patients suggests a notable advantage of robotic approach for these individuals.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ags3.70005","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T22:43:39Z","timestamp":1741733019000},"page":"861-869","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Institutional learning curve and factors of prolonged operation time of robotic distal pancreatectomy: An analysis of an initial 117 cases"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0283-6392","authenticated-orcid":false,"given":"Yuki","family":"Hirata","sequence":"first","affiliation":[{"name":"Department of Surgery National Hospital Organization Tokyo Medical Center  Tokyo Japan"},{"name":"Department of Surgical Oncology The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Prakash","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jess","family":"Maxwell","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Snyder","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hop","family":"Tran Cao","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching\u2010Wei D.","family":"Tzeng","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jefferey E.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew H. 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