Abstract
OBJECTIVE:: To evaluate the "learning curve" effect on feasibility and reproducibility of laparoscopic liver resection (LLR). SUMMARY BACKGROUND DATA:: LLR is currently limited to few centers and to few procedures. Its reproducibility is still debated. METHODS:: Patients undergoing LLR between 1996 and 2008 were included. Indications and type of hepatectomies were compared with those of open resections performed in the same period, considering 3 periods (1996-1999, 2000-2003, and 2004-2008). LLRs were divided into 3 equal groups of 58 cases and technical data and outcomes were compared. Risk-adjusted Cumulative Sum model was used for determining the learning curve based on the need for conversion. RESULTS:: Of 782, 174 (22.3%) patients underwent LLR. Proportion of LLR progressively increased (17.5%, 22.4%, and 24.2%), such as hepatocellular carcinoma (17.6%, 25.6%, and 39.4%, P <0.05), colorectal metastases (0%, 6.5%, and 13.1%, P <0.05), major hepatectomies (1.1%, 9.1%, 8.5%, P <0.05), and right hepatectomies (0%, 13.2%, and 13.1%, P <0.05). Comparing groups, results of LLR significantly improved in terms of conversion rate (15.5%, 10.3%, and 3.4%, P <0.05), operative time (210, 180, and 150 minutes, P <0.05), blood loss (300, 200, and 200 mL, P <0.05), and morbidity (17.2%, 22.4%, and 3.4%, P <0.05). Pedicle clamping was less used over time (77.6%, 62.1%, and 17.2%, P <0.05) and for shorter durations (45, 30, and 20 minutes, P <0.05). Having adjusted for case-mix, the Cumulative Sum analysis demonstrated a learning curve for laparoscopic hepatectomies of 60 cases. CONCLUSION:: A slow but constant evolution of LLR occurred: indications and magnitude of procedures increased and technical outcomes improved. The learning curve demonstrated in this study suggests that LLR is reproducible in liver units but specific training to advanced laparoscopy is required.
| Original language | English |
|---|---|
| Pages (from-to) | 772-780 |
| Number of pages | 9 |
| Journal | Annals of Surgery |
| Volume | 250 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - Nov 2009 |
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ASJC Scopus subject areas
- Surgery
Cite this
The learning curve in laparoscopic liver resection : Improved feasibility and reproducibility. / Vigano, Luca; Laurent, Alexis; Tayar, Claude; Tomatis, Mariano; Ponti, Antonio; Cherqui, Daniel.
In: Annals of Surgery, Vol. 250, No. 5, 11.2009, p. 772-780.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The learning curve in laparoscopic liver resection
T2 - Improved feasibility and reproducibility
AU - Vigano, Luca
AU - Laurent, Alexis
AU - Tayar, Claude
AU - Tomatis, Mariano
AU - Ponti, Antonio
AU - Cherqui, Daniel
PY - 2009/11
Y1 - 2009/11
N2 - OBJECTIVE:: To evaluate the "learning curve" effect on feasibility and reproducibility of laparoscopic liver resection (LLR). SUMMARY BACKGROUND DATA:: LLR is currently limited to few centers and to few procedures. Its reproducibility is still debated. METHODS:: Patients undergoing LLR between 1996 and 2008 were included. Indications and type of hepatectomies were compared with those of open resections performed in the same period, considering 3 periods (1996-1999, 2000-2003, and 2004-2008). LLRs were divided into 3 equal groups of 58 cases and technical data and outcomes were compared. Risk-adjusted Cumulative Sum model was used for determining the learning curve based on the need for conversion. RESULTS:: Of 782, 174 (22.3%) patients underwent LLR. Proportion of LLR progressively increased (17.5%, 22.4%, and 24.2%), such as hepatocellular carcinoma (17.6%, 25.6%, and 39.4%, P <0.05), colorectal metastases (0%, 6.5%, and 13.1%, P <0.05), major hepatectomies (1.1%, 9.1%, 8.5%, P <0.05), and right hepatectomies (0%, 13.2%, and 13.1%, P <0.05). Comparing groups, results of LLR significantly improved in terms of conversion rate (15.5%, 10.3%, and 3.4%, P <0.05), operative time (210, 180, and 150 minutes, P <0.05), blood loss (300, 200, and 200 mL, P <0.05), and morbidity (17.2%, 22.4%, and 3.4%, P <0.05). Pedicle clamping was less used over time (77.6%, 62.1%, and 17.2%, P <0.05) and for shorter durations (45, 30, and 20 minutes, P <0.05). Having adjusted for case-mix, the Cumulative Sum analysis demonstrated a learning curve for laparoscopic hepatectomies of 60 cases. CONCLUSION:: A slow but constant evolution of LLR occurred: indications and magnitude of procedures increased and technical outcomes improved. The learning curve demonstrated in this study suggests that LLR is reproducible in liver units but specific training to advanced laparoscopy is required.
AB - OBJECTIVE:: To evaluate the "learning curve" effect on feasibility and reproducibility of laparoscopic liver resection (LLR). SUMMARY BACKGROUND DATA:: LLR is currently limited to few centers and to few procedures. Its reproducibility is still debated. METHODS:: Patients undergoing LLR between 1996 and 2008 were included. Indications and type of hepatectomies were compared with those of open resections performed in the same period, considering 3 periods (1996-1999, 2000-2003, and 2004-2008). LLRs were divided into 3 equal groups of 58 cases and technical data and outcomes were compared. Risk-adjusted Cumulative Sum model was used for determining the learning curve based on the need for conversion. RESULTS:: Of 782, 174 (22.3%) patients underwent LLR. Proportion of LLR progressively increased (17.5%, 22.4%, and 24.2%), such as hepatocellular carcinoma (17.6%, 25.6%, and 39.4%, P <0.05), colorectal metastases (0%, 6.5%, and 13.1%, P <0.05), major hepatectomies (1.1%, 9.1%, 8.5%, P <0.05), and right hepatectomies (0%, 13.2%, and 13.1%, P <0.05). Comparing groups, results of LLR significantly improved in terms of conversion rate (15.5%, 10.3%, and 3.4%, P <0.05), operative time (210, 180, and 150 minutes, P <0.05), blood loss (300, 200, and 200 mL, P <0.05), and morbidity (17.2%, 22.4%, and 3.4%, P <0.05). Pedicle clamping was less used over time (77.6%, 62.1%, and 17.2%, P <0.05) and for shorter durations (45, 30, and 20 minutes, P <0.05). Having adjusted for case-mix, the Cumulative Sum analysis demonstrated a learning curve for laparoscopic hepatectomies of 60 cases. CONCLUSION:: A slow but constant evolution of LLR occurred: indications and magnitude of procedures increased and technical outcomes improved. The learning curve demonstrated in this study suggests that LLR is reproducible in liver units but specific training to advanced laparoscopy is required.
UR - http://www.scopus.com/inward/record.url?scp=70449337459&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=70449337459&partnerID=8YFLogxK
U2 - 10.1097/SLA.0b013e3181bd93b2
DO - 10.1097/SLA.0b013e3181bd93b2
M3 - Article
C2 - 19801926
AN - SCOPUS:70449337459
VL - 250
SP - 772
EP - 780
JO - Annals of Surgery
JF - Annals of Surgery
SN - 0003-4932
IS - 5
ER -