Evaluating the learning curve for laparoscopic liver resection: a comparative study between standard and learning curve CUSUM

Sultana, Asma; Marudanayagam, R.; Sutcliffe, Robert P.

doi:10.1016/j.hpb.2019.03.362

Cited by 31 publications

(22 citation statements)

References 32 publications

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“…The learning curve in minimally invasive liver surgery is a popular subject of research [ 11 , 25 , 26 ]. The reported learning curve ranges from 18 to 100 cases, depending on resection type and outcomes.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Liver Surgery: A Snapshot from a Major Dutch HPB and Transplant Center

et al. 2022

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Background Minimally invasive liver surgery (MILS) has been progressively adopted on a nationwide scale. The aim of this study is to investigate MILS implementation in a high-volume Dutch hepato-pancreato-biliary and transplant center, which is considered a moderate to low-volume center from a European standpoint. Methods All patients who underwent MILS at Erasmus Medical Center between April 2010 and December 2021 were retrospectively reviewed. Patients’ surgical outcomes were compared after stratification according to resections’ difficulty and liver cirrhosis. Results A total of 212 cases were included. Major liver resections were performed in 24 patients (11%), while minor resections were performed in 188 patients (89%). Among those, 177 (94%) resections were classified as technically minor and 11 (6%) as technically major. Major morbidity was reported in 14/177 patients (8%) after technically minor resections and in 3/24 patients (13%) after major resections. Anatomically and technically major resections had higher intraoperative blood losses (425 (0–2100) vs. 240 (50–110) vs. 100 (0–2400) mL; p-value < 0.001) and longer hospital stay (6 (3–25) vs. 5 (2–9) vs. 3 (1–44); p-value < 0.001) when compared with the technically minor counterpart. Perioperative outcomes were similar when comparing cirrhotic MILS with the non-cirrhotic cohort. Conclusion MILS program implementation can lead to encouraging surgical outcomes even in low- to moderate-volume centers. Although low procedural volume might be predictive of impaired outcomes, long-standing experience in the HPB and liver transplant field could mitigate low-case volume effects on surgical outcomes.

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Section: Discussionmentioning

confidence: 99%

Minimally Invasive Liver Surgery: A Snapshot from a Major Dutch HPB and Transplant Center

et al. 2022

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“…Laparoscopic hepatectomies are technically demanding procedures with reported learning curves of about 25 cases for minor hepatectomies to 45-75 cases for major hepatectomies. [23][24][25][26] Hence, opponents of the approach have frequently cited the steep learning curve required to perform the procedure as a major obstacle to its widespread adoption. Furthermore, questions have also been raised on its applicability to teaching institutions due to the need for well-trained surgical assistants.…”

Section: Discussionmentioning

confidence: 99%

Impact of First Assistant Surgeon Experience on the Perioperative Outcomes of Laparoscopic Hepatectomies

Cai

Syn

Koh

et al. 2020

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Introduction: This study aims to evaluate the impact of first assistant surgeon experience on the outcomes of laparoscopic hepatectomies in a university-affiliated teaching hospital. Methods: This is a retrospective study comparing outcomes of laparoscopic hepatectomies with first assistant surgeons of varying experience levels. Three hundred and eighty-five consecutive laparoscopic hepatectomies performed in a tertiary university-affiliated teaching hospital from 2012 to 2018 were included and stratified into three cohorts-Group 1 in which assistants were residents, Group 2 for fellows, and Group 3 for attendings. Baseline clinicopathologic variables and outcome measures were analyzed using the augmented inverse probability of treatment weighting approach, which is a propensity score-based method that combines aspects of covariate adjustment and inverse probability weighting. Results: Group 3 comprised a greater proportion of advanced-and expert-level surgeries based on the Iwate criteria; 33.8%, 32.2%, and 46.0% of patients underwent advanced-and expert-level surgeries in Groups 1, 2, and 3, respectively. Group 3 had consistently higher operative times as well as more frequent use and longer duration of Pringle's maneuver (P < .05). The median operative times for Groups 1, 2, and 3 were 195, 195, and 290 minutes, respectively. Pringle's maneuver was applied in 26.9%, 33.9%, and 60.2% of patients with a corresponding median duration of 35, 36, and 45 minutes, respectively. None of the other perioperative and postoperative outcomes demonstrated statistically significant differences. Conclusion: With an appropriate selection of cases, participation of residents as first assistants in laparoscopic hepatectomies can be encouraged without compromise in perioperative outcomes.

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“…In China, thermal ablation can be performed by clinician in the departments of interventional ultrasound, interventional radiography, and hepatobiliary surgery etc. However, the learning process of this technique does not attract the same attention as laparoscopic liver resection, roboticassisted laparoscopic colorectal surgery, and laparoscopic cholecystectomy (25)(26)(27). Previous studies mentioned that the complication rates range from 1.3 to 10% (10)(11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%

The Learning Curve for Thermal Ablation of Liver Cancers: 4,363-Session Experience for a Single Central in 18 Years

et al. 2020

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This study aimed to explore the special efforts required to achieve proficiency in performing thermal ablation of liver cancers, including tumors in difficult locations, and clarify the effects of handing-down teaching on the corresponding process. Major complications of patients receiving percutaneous thermal ablation of liver cancer were analyzed. Polynomial fitting was used to describe the connection between major complication rates and special experience. Learning curve of major complications was plotted both for the whole group and for each operator, respectively. Tumors in difficult locations were further studied. A total of 4,363 thermal ablation sessions were included in this study. 143 of 4,363 patients had major complications, corresponding to an incidence rate of 3.27%. 806 thermal ablation sessions were performed for tumors in difficult locations. The major complication rate of these sessions is 6.33%. According to the trend of the learning curve of the 4363 patients, the experience of the whole group can be classified into five stages, that is, the high-risk, relatively stable, unstable, proficient and stable periods. A learning curve for an individual operator can be classified into the highrisk, proficient and stable periods. The major complication rates for the chronologically first, second and third operator of the group are 3.23, 3.35, and 3.31%, respectively. The special experience needed to bypass the first stage corresponds to 410, 510, and 440 sessions, the second stage, 1850, 850, and 870 sessions, by the three operators, respectively. The major complication rates for the tumors in difficult locations for the first, second and third operator were 7.04, 5.53, and 5.98%, respectively. For the tumors in difficult locations, the special experience needed to bypass the first stage corresponds to 150, 130, and 140 sessions, the second stage, 290, 175, and 185 sessions, by the three operators, respectively. In conclusion, the learning process of an operator percutaneous

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Evaluating the learning curve for laparoscopic liver resection: a comparative study between standard and learning curve CUSUM

Cited by 31 publications

References 32 publications

Minimally Invasive Liver Surgery: A Snapshot from a Major Dutch HPB and Transplant Center

Minimally Invasive Liver Surgery: A Snapshot from a Major Dutch HPB and Transplant Center

Impact of First Assistant Surgeon Experience on the Perioperative Outcomes of Laparoscopic Hepatectomies

The Learning Curve for Thermal Ablation of Liver Cancers: 4,363-Session Experience for a Single Central in 18 Years

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