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Learning curve of self-taught laparoscopic liver surgeons in left lateral sectionectomy: results from an international multi-institutional analysis on 245 cases

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Abstract

Background

Laparoscopy was suggested as gold standard for left lateral sectionectomy (LLS), thanks to recognized benefits compared to open approach. Aim of this study was to define learning curve (LC) of laparoscopic LLS (LLLS) using operative time (OT) as tool to analyze outcome of procedures performed by four experienced surgeons. Reproducibility and safety of LC in LLLS among independent surgeons were also analyzed as essential features of “standard procedure” concept.

Methods

LLLS performed by four experienced surgeons was collected. Multivariate analysis was carried out to screen factors affecting OT. A cumulative LC was created calculating median OT. Skewness of OT was analyzed, and ROC curve was carried out to identify the cutoff for LC. The impact of LC on outcomes (morbidity and mortality, blood loss, conversions, surgical margins and length of stay) was determined.

Results

A total of 245 LLLSs were collected. Conversion rate was 1.2 %. Median OT was 141 min, blood loss 100 mL, morbidity 11.4 % and mortality 0.4 %. “Associated procedures” was the only independent factor affecting OT. The skewness of the OT was calculated, and the cutoff point for LC was determined after 15 LLLSs. LLLS performed during and after LC period had similar outcomes.

Conclusion

LLLS is feasible with low morbidity, mortality and conversion rate. LC in LLLS is shorter compared to minor liver resections. Furthermore, it is reproducible and safe since it does not negatively affect clinical outcome. A reproducible, safe and short LC contributes to considering laparoscopy as the gold standard approach to perform LLS.

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Abbreviations

LLS:

Left lateral sectionectomy

LLLS:

Laparoscopic left lateral sectionectomy

LC:

Learning curve

CR:

Conversion rate

OT:

Operative time

BMI:

Body mass index

WS:

Whole series

HCC:

Hepatocellular carcinoma

LC group:

Learning curve group

PLC group:

Postlearning curve group

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Authors and Affiliations

  1. Hepatobiliary Surgery Unit, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy

    Francesca Ratti, Federica Cipriani & Luca Aldrighetti

  2. Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital Medical School, Ghent, Belgium

    Federico Tomassini & Roberto I. Troisi

  3. University Surgical Unit, Southampton General Hospital, NHS Foundation Trust, Southampton, UK

    Federica Cipriani & Mohammad Abu Hilal

  4. Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway

    Leonid I. Barkhatov, Airazat M. Kazaryan & Bjǿrn Edwin

  5. Department of Hepatopancreatobiliary Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway

    Bjǿrn Edwin

  6. Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway

    Leonid I. Barkhatov & Bjǿrn Edwin

  7. Department of Surgery, Finnmark Hospital, Kirkenes, Norway

    Airazat M. Kazaryan

Authors
  1. Francesca Ratti
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  2. Leonid I. Barkhatov
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  3. Federico Tomassini
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  4. Federica Cipriani
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  5. Airazat M. Kazaryan
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  6. Bjǿrn Edwin
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  7. Mohammad Abu Hilal
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  8. Roberto I. Troisi
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  9. Luca Aldrighetti
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Correspondence to Francesca Ratti.

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Disclosures

Drs Ratti, Barkhatov, Tomassini, Cipriani, Kazaryan, Edwin, Abu Hilal, Troisi and Aldrighetti have no conflicts of interest to disclose and further disclose any commercial interest that they may have in the subject of study and the source of any financial or material support.

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Ratti, F., Barkhatov, L.I., Tomassini, F. et al. Learning curve of self-taught laparoscopic liver surgeons in left lateral sectionectomy: results from an international multi-institutional analysis on 245 cases. Surg Endosc 30, 3618–3629 (2016). https://doi.org/10.1007/s00464-015-4665-0

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