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Technical aspects and learning curve of complex laparoscopic hepatectomy: how we do it.
- Source :
-
Surgical endoscopy [Surg Endosc] 2024 Aug; Vol. 38 (8), pp. 4583-4593. Date of Electronic Publication: 2024 Jul 01. - Publication Year :
- 2024
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Abstract
- Introduction: Laparoscopic liver surgery has advanced significantly, offering benefits, such as reduced intraoperative complications and quicker recovery. However, complex laparoscopic hepatectomy (CLH) is technically demanding, requiring skilled surgeons. This study aims to share technical aspects, insightful tips, and outcomes of CLH at our center, focusing on the safety and learning curve.<br />Methods: We reviewed all patients undergoing liver resection at our center from July 2017 to December 2023, focusing on those who underwent CLH. Of 135 laparoscopic liver resections, 63 (46.7%) were CLH. The learning curve of CLH was also assessed through linear and piecewise regression analyses considering the operation time and intraoperative blood loss.<br />Results: Postoperative complications occurred only in 4.8% of patients, with a 90-day mortality rate of 3.2%. The mean operation time and blood loss significantly decreased after the first 20 operations, marking the learning curve's optimal cut-off. Significant improvements in R0 resection (pā=ā0.024) and 90-day mortality (pā=ā0.035) were noted beyond the learning curve threshold.<br />Conclusion: CLH is a safe and effective approach, with a relatively short learning curve of 20 operations. Future large-scale studies should further investigate the impact of surgical experience on CLH outcomes to establish guidelines for training programs.<br /> (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
- Subjects :
- Humans
Female
Male
Middle Aged
Aged
Retrospective Studies
Adult
Liver Neoplasms surgery
Liver Neoplasms mortality
Clinical Competence
Hepatectomy education
Hepatectomy methods
Learning Curve
Laparoscopy education
Laparoscopy methods
Operative Time
Postoperative Complications epidemiology
Postoperative Complications etiology
Blood Loss, Surgical statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1432-2218
- Volume :
- 38
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Surgical endoscopy
- Publication Type :
- Academic Journal
- Accession number :
- 38951242
- Full Text :
- https://doi.org/10.1007/s00464-024-11002-7