Learning curve of self-taught laparoscopic liver surgeons in left lateral sectionectomy: results from an international multi-institutional analysis on 245 cases

Francesca Ratti, Leonid I. Barkhatov, Federico Tomassini, Federica Cipriani, Airazat M. Kazaryan, Bjǿrn Edwin, Mohammad Abu Hilal, Roberto I. Troisi, Luca Aldrighetti

Research output: Contribution to journalArticle

24 Citations (Scopus)

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.

Original languageEnglish
JournalSurgical Endoscopy and Other Interventional Techniques
DOIs
Publication statusAccepted/In press - Nov 16 2015

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Learning Curve
Operative Time
Liver
Morbidity
Laparoscopy
Mortality
Surgeons
ROC Curve
Length of Stay
Multivariate Analysis
Safety

Keywords

  • Laparoscopy
  • Learning curve
  • Left lateral sectionectomy
  • Liver surgery
  • Standard

ASJC Scopus subject areas

  • Surgery

Cite this

Learning curve of self-taught laparoscopic liver surgeons in left lateral sectionectomy : results from an international multi-institutional analysis on 245 cases. / Ratti, Francesca; Barkhatov, Leonid I.; Tomassini, Federico; Cipriani, Federica; Kazaryan, Airazat M.; Edwin, Bjǿrn; Abu Hilal, Mohammad; Troisi, Roberto I.; Aldrighetti, Luca.

In: Surgical Endoscopy and Other Interventional Techniques, 16.11.2015.

Research output: Contribution to journalArticle

Ratti, Francesca ; Barkhatov, Leonid I. ; Tomassini, Federico ; Cipriani, Federica ; Kazaryan, Airazat M. ; Edwin, Bjǿrn ; Abu Hilal, Mohammad ; Troisi, Roberto I. ; Aldrighetti, Luca. / Learning curve of self-taught laparoscopic liver surgeons in left lateral sectionectomy : results from an international multi-institutional analysis on 245 cases. In: Surgical Endoscopy and Other Interventional Techniques. 2015.
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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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author = "Francesca Ratti and Barkhatov, {Leonid I.} and Federico Tomassini and Federica Cipriani and Kazaryan, {Airazat M.} and Bjǿrn Edwin and {Abu Hilal}, Mohammad and Troisi, {Roberto I.} and Luca Aldrighetti",
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AU - Ratti, Francesca

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AU - Tomassini, Federico

AU - Cipriani, Federica

AU - Kazaryan, Airazat M.

AU - Edwin, Bjǿrn

AU - Abu Hilal, Mohammad

AU - Troisi, Roberto I.

AU - Aldrighetti, Luca

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N2 - 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.

AB - 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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