Learning Curve Under Proctorship of Pure Laparoscopic Living Donor Left Lateral Sectionectomy for Pediatric Transplantation

Bröering, Dieter C.; Berardi, Giammauro; Sheikh, Yasser El; Spagnoli, Alessandra; Troisi, Roberto

doi:10.1097/sla.0000000000002948

Cited by 39 publications

(35 citation statements)

References 46 publications

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“…The mean operative duration of LLLS was 157.5 ± 29.7 minutes, and the mean intraoperative blood loss was 160.4 ± 97.5 mL, which are comparable to or even better than those of open surgery. (8)(9)(10)(11) The operative duration was even shorter than that at other centers, as previously reported. (8,12) The use of a harmonic scalpel instead of a cavitron ultrasound surgical aspirator during transection of the liver parenchyma is the main reason for the shorter operative duration.…”

Section: Discussionsupporting

confidence: 60%

Left Hepatic Vein Preferential Approach Based on Anatomy Is Safe and Feasible for Laparoscopic Living Donor Left Lateral Sectionectomy

Lu¹,

Wang²,

Zhu³

et al. 2020

Liver Transpl.

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We assess the safety and feasibility of the left hepatic vein preferential approach (LHVPA) based on left hepatic vein (LHV) anatomy for living donor laparoscopic left lateral sectionectomy (LLLS). Data from 50 donors who underwent LLLS in Huashan Hospital from October 2016 to November 2019 were analyzed retrospectively. On the basis of the classification of the LHV anatomy, the vein was defined as the direct import type, upper branch type, or indirect import type. A subgroup analysis was performed to compare the outcomes between the LHVPA and non-LHVPA groups. All 50 patients underwent pure LLLS. The mean operative duration was 157.5 ± 29.7 minutes. The intraoperative blood loss was 160.4 ± 97.5 mL. No complications more severe than grade 3 occurred. LHVPA was applied in 13 patients, whereas non-LHVPA was applied in 10 patients with the direct import type and upper branch type anatomy. The operative duration was shorter in the LHVPA group than the non-LHVPA group (142.7 ± 22.0 versus 173.0 ± 22.8 minutes; P = 0.01). Intraoperative blood loss was reduced in the LHVPA group compared with the non-LHVPA group (116.2 ± 45.6 versus 170.0 ± 63.3 mL; P = 0.02). The length of the LHV reserved extrahepatically in the LHVPA group was longer than in the non-LHVPA group (4.3 ± 0.2 versus 3.3 ± 0.3 mm; P = 0.01). Fewer reconstructions of the LHV in the direct import type anatomy were required for the LHVPA group than for the non-LHVPA group (0/8 versus 4/6). LHVPA based on the LHV anatomy is recommended in LLLS because it can further increase the safety and the efficiency of surgery for suitable donors.

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Section: Discussionsupporting

confidence: 60%

Left Hepatic Vein Preferential Approach Based on Anatomy Is Safe and Feasible for Laparoscopic Living Donor Left Lateral Sectionectomy

Lu¹,

Wang²,

Zhu³

et al. 2020

Liver Transpl.

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“…The learning curve was completed after less than 70 cases for anatomical resections. This is quite high compared with the data for minor resections, but reasonable considering that such resections have the highest level of difficulty. Most likely a surgeon approaching LLR today would not have to undergo the same exploration and development phases; specific training, workshops, fellowship programmes and proctored learning are essential to shorten the learning curve.…”

Section: Discussionmentioning

confidence: 95%

“…The European Guidelines on Laparoscopic Liver Surgery define the learning curve for left lateral sectionectomies, minor resections and major hepatectomies at 15–20, 25–40 and 45–70 procedures respectively. Even laparoscopic left lateral sectionectomy for paediatric transplantation can be reproduced successfully through a proctored learning curve.…”

Section: Introductionmentioning

confidence: 99%

Multicentre analysis of the learning curve for laparoscopic liver resection of the posterosuperior segments

Berardi

Fretland

Elberm

et al. 2019

British Journal of Surgery

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Background: Laparoscopic liver resection demands expertise and a long learning curve. Resection of the posterosuperior segments is challenging, and there are no data on the learning curve. The aim of this study was to evaluate the learning curve for laparoscopic resection of the posterosuperior segments.Methods: A cumulative sum (CUSUM) analysis of the difficulty score for resection was undertaken using patient data from four specialized centres. Risk-adjusted CUSUM analysis of duration of operation, blood loss and conversions was performed, adjusting for the difficulty score of the procedures. A receiver operating characteristic (ROC) curve was used to identify the completion of the learning curve.Results: According to the CUSUM analysis of 464 patients, the learning curve showed an initial decrease in the difficulty score followed by an increase and, finally, stabilization. More patients with cirrhosis or previous surgery were operated in the latest phase of the learning curve. A smaller number of wedge resections and a larger number of anatomical resections were performed progressively. Dissection using a Cavitron ultrasonic surgical aspirator and the Pringle manoeuvre were used more frequently with time. Risk-adjusted CUSUM analysis showed a progressive decrease in operating time. Blood loss initially increased slightly, then stabilized and finally decreased over time. A similar trend was found for conversions. The learning curve was estimated to be 40 procedures for wedge and 65 for anatomical resections.Conclusion: The learning curve for laparoscopic liver resection of the posterosuperior segments consists of a stepwise process, during which accurate patient selection is key.

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“…Especially laparoscopic left lateral sectionectomy is meanwhile a standard procedure in specialized units yielding expected advantages in the donor with comparable short and long-term outcome to open surgery in the recipient [ 69 – 71 ]. However, a learning curve of 25 fully laparoscopic living donor left lateral sectionectomies under proctorship for an expert liver transplantation surgeon was recently suggested, which indicates that safe introduction of laparoscopic minor liver resections is restricted to high volume LDLT centers [ 72 ]. The significance of major liver resection in LDLT has not yet been conclusively clarified [ 73 ].…”

Section: Limitationsmentioning

confidence: 99%

Laparoscopic liver resection: indications, limitations, and economic aspects

Schmelzle

Krenzien

Schöning

et al. 2020

Langenbecks Arch Surg

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Background Minimally invasive techniques have increasingly found their way into liver surgery in recent years. A multitude of mostly retrospective analyses suggests several advantages of laparoscopic over open liver surgery. Due to the speed and variety of simultaneous technical and strategic developments, it is difficult to maintain an overview of the current status and perspectives in laparoscopic liver surgery. Purpose This review highlights up-to-date aspects in laparoscopic liver surgery. We discuss established indications with regard to their development over time as well as continuing limitations of applied techniques. We give an assessment based on the current literature and according to our own center experiences, not least with regard to a highly topical cost discussion. Conclusions While in the beginning mainly benign tumors were laparoscopically operated on, liver metastasis and hepatocellular carcinoma are now among the most frequent indications. Technical limitations remain and should be evaluated with the overall aim not to endanger quality standards in open surgery. Financial aspects cannot be neglected with the necessity of cost-covering reimbursement.

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Learning Curve Under Proctorship of Pure Laparoscopic Living Donor Left Lateral Sectionectomy for Pediatric Transplantation

Abstract: L-LLS is a safe procedure that can be standardized and successfully taught to surgeons with large experience in donor hepatectomy through a proctored learning curve.

Cited by 39 publications

References 46 publications

Left Hepatic Vein Preferential Approach Based on Anatomy Is Safe and Feasible for Laparoscopic Living Donor Left Lateral Sectionectomy

Left Hepatic Vein Preferential Approach Based on Anatomy Is Safe and Feasible for Laparoscopic Living Donor Left Lateral Sectionectomy

Multicentre analysis of the learning curve for laparoscopic liver resection of the posterosuperior segments

Laparoscopic liver resection: indications, limitations, and economic aspects

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