Learning curve of self-taught laparoscopic liver surgeons in left lateral sectionectomy: results from an international multi-institutional analysis on 245 cases
Learning curve of self-taught laparoscopic liver surgeons in left lateral sectionectomy: results from an international multi-institutional analysis on 245 cases
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.
3618-3629
Ratti, Francesca
6ee4b291-99b0-48c7-b983-6f0f9e14d90d
Barkhatov, Leonid I.
ea3415dd-a9d2-44f5-9bee-587844e400ee
Tomassini, Federico
09de5c91-8c3e-4b52-8e8f-81638f85288d
Cipriani, Federica
aca25573-d300-425d-ba9c-20be3190ce2e
Kazaryan, Airazat M.
7adf4cee-740f-4b4f-bf19-617c51b8b837
Edwin, Bjǿrn
d74c26f4-7ccc-4155-94cc-e67a0330b214
Abu Hilal, Mohammad
384e1c60-8519-4eed-8e92-91775aad4c47
Troisi, Roberto I.
13220f60-fb66-44c5-b957-0f9a5936b0c7
Aldrighetti, Luca
bab36581-c535-4f90-970d-0a982fe7a244
August 2016
Ratti, Francesca
6ee4b291-99b0-48c7-b983-6f0f9e14d90d
Barkhatov, Leonid I.
ea3415dd-a9d2-44f5-9bee-587844e400ee
Tomassini, Federico
09de5c91-8c3e-4b52-8e8f-81638f85288d
Cipriani, Federica
aca25573-d300-425d-ba9c-20be3190ce2e
Kazaryan, Airazat M.
7adf4cee-740f-4b4f-bf19-617c51b8b837
Edwin, Bjǿrn
d74c26f4-7ccc-4155-94cc-e67a0330b214
Abu Hilal, Mohammad
384e1c60-8519-4eed-8e92-91775aad4c47
Troisi, Roberto I.
13220f60-fb66-44c5-b957-0f9a5936b0c7
Aldrighetti, Luca
bab36581-c535-4f90-970d-0a982fe7a244
Ratti, Francesca, Barkhatov, Leonid I., Tomassini, Federico, Cipriani, Federica, Kazaryan, Airazat M., Edwin, Bjǿrn, Abu Hilal, Mohammad, Troisi, Roberto I. and Aldrighetti, Luca
(2016)
Learning curve of self-taught laparoscopic liver surgeons in left lateral sectionectomy: results from an international multi-institutional analysis on 245 cases.
Surgical Endoscopy, 30 (8), .
(doi:10.1007/s00464-015-4665-0).
(PMID:26572765)
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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More information
Accepted/In Press date: 2 November 2015
e-pub ahead of print date: 16 November 2015
Published date: August 2016
Organisations:
Cancer Sciences
Identifiers
Local EPrints ID: 400309
URI: http://eprints.soton.ac.uk/id/eprint/400309
ISSN: 0930-2794
PURE UUID: 7d46b9b5-c12f-49c6-9132-544caf88c201
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Date deposited: 14 Sep 2016 10:24
Last modified: 15 Mar 2024 02:14
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Contributors
Author:
Francesca Ratti
Author:
Leonid I. Barkhatov
Author:
Federico Tomassini
Author:
Federica Cipriani
Author:
Airazat M. Kazaryan
Author:
Bjǿrn Edwin
Author:
Mohammad Abu Hilal
Author:
Roberto I. Troisi
Author:
Luca Aldrighetti
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