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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.
- Source :
-
Surgical endoscopy [Surg Endosc] 2016 Aug; Vol. 30 (8), pp. 3618-29. Date of Electronic Publication: 2015 Nov 16. - Publication Year :
- 2016
-
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.<br />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.<br />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.<br />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.
- Subjects :
- Adult
Aged
Aged, 80 and over
Blood Loss, Surgical statistics & numerical data
Clinical Competence statistics & numerical data
Female
Hepatectomy education
Humans
Laparoscopy education
Length of Stay statistics & numerical data
Liver surgery
Liver Neoplasms mortality
Male
Middle Aged
Multivariate Analysis
Operative Time
Reproducibility of Results
Retrospective Studies
Young Adult
Hepatectomy methods
Laparoscopy methods
Learning Curve
Liver Neoplasms surgery
Surgeons education
Subjects
Details
- Language :
- English
- ISSN :
- 1432-2218
- Volume :
- 30
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Surgical endoscopy
- Publication Type :
- Academic Journal
- Accession number :
- 26572765
- Full Text :
- https://doi.org/10.1007/s00464-015-4665-0