The learning curve in laparoscopic liver resection: Improved feasibility and reproducibility

Luca Vigano, Alexis Laurent, Claude Tayar, Mariano Tomatis, Antonio Ponti, Daniel Cherqui

Research output: Contribution to journalArticle

203 Citations (Scopus)

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 languageEnglish
Pages (from-to)772-780
Number of pages9
JournalAnnals of Surgery
Volume250
Issue number5
DOIs
Publication statusPublished - Nov 2009

Fingerprint

Learning Curve
Liver
Hepatectomy
Diagnosis-Related Groups
Operative Time
Constriction
Laparoscopy
Hepatocellular Carcinoma
Neoplasm Metastasis
Morbidity

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 journalArticle

Vigano, Luca ; Laurent, Alexis ; Tayar, Claude ; Tomatis, Mariano ; Ponti, Antonio ; Cherqui, Daniel. / The learning curve in laparoscopic liver resection : Improved feasibility and reproducibility. In: Annals of Surgery. 2009 ; Vol. 250, No. 5. pp. 772-780.
@article{3ca320f8e8a3460391f2f34fa5ca285f,
title = "The learning curve in laparoscopic liver resection: Improved feasibility and reproducibility",
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.",
author = "Luca Vigano and Alexis Laurent and Claude Tayar and Mariano Tomatis and Antonio Ponti and Daniel Cherqui",
year = "2009",
month = "11",
doi = "10.1097/SLA.0b013e3181bd93b2",
language = "English",
volume = "250",
pages = "772--780",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

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 -