Video Assessment of Surgical Performance in Robotic Gastroenterostomy During Pancreatoduodenectomy: Evaluating the Learning Curve and Risk of Delayed Gastric Emptying

Objective: – To identify learning curves for robotic gastroenterostomy (RGE) during robotic pancreatoduodenectomy (RPD) and the predictive value of the objective structured assessment of technical skills (OSATS) score for delayed gastric emptying (DGE) according to the Birkmeyer and colleagues and University of Pittsburgh Medical Center method. Background: – In some series, RPD has been associated with an increased risk of DGE. It is unclear whether this is attributable to learning curve. Improved surgical performance and experience have not yet been linked to a decrease in DGE in RPD. Methods: – Post hoc study of the prospective multicenter (LAELAPS-3) training program, including videos of RGE during RPD. Surgical performance was scored with OSATS by 2 blinded graders. The main outcomes are the combined OSATS scores of 2 blinded graders over time (learning curve). Secondary outcome is the correlation between OSATS scores and clinically relevant DGE (grade B/C). Results: – Videos from 192 RGE anastomoses were included. DGE occurred in 42/192 (21.9%) patients. The mean OSATS score was 22.4 (SD ± 5.1) and predicted DGE Area under the curve (AUC): 0.668, P < 0.001). The predictive OSATS elements for DGE were gentleness (AUC: 0.719, P < 0.001), instrument handling (AUC: 0.595 P = 0.043), tissue exposure (AUC: 0.625, P = 0.009), and summary score (AUC: 0.665, P < 0.001). An OSATS score >25 was associated with a 59.9% reduced relative risk of grade B/C DGE [11.3% (8/71) vs 28.1% (34/121); odds ratio (OR): 0.325, P = 0.006]. Cumulative sum analysis of RGE-OSATS identified a turning point at 34 procedures [25.7% (36/140) before vs 11.5% (6/52) after; OR: 0.156, P = 0.035]. On multivariable analysis for grade B/C DGE, OSATS ≤25 remained an independent risk factor (OR: 2.907, P = 0.028). Conclusions: – Better surgical performance during gastroenteric anastomosis in RPD, as assessed by OSATS, is associated with a reduced rate of grade B/C DGE. OSATS could serve as a tool for competency-based training programs and quality-controlled implementation of RPD. Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, LLC.