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16-06-2023 | Cholangiography | Original Scientific Report

Risk-Adjusted Assessment of the Learning Curve for Pure Laparoscopic Donor Hepatectomy for Adult Recipients

Authors: Koji Kikuchi, Hiroyuki Nitta, Akira Umemura, Hirokatsu Katagiri, Shoji Kanno, Daiki Takeda, Taro Ando, Satoshi Amano, Akira Sasaki

Published in: World Journal of Surgery | Issue 10/2023

Abstract

Background

Studies on pure laparoscopic donor hepatectomy (PLDH) have been reported. However, only few studies have reported on the learning curve of PLDH. In this report, we aimed to determine the learning curve of PLDH in adult patients using cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) analyses.

Methods

The data of donors who underwent PLDH at a single center between December 2012 and May 2022 were retrospectively reviewed. The learning curve was evaluated using the CUSUM and RA-CUSUM methods based on surgery duration.

Results

Forty-eight patients were finally included in the present study. The mean operation time was 393.6 ± 80.3 min. PLDH was converted to laparotomy in three cases (6.3%). According to the Clavien–Dindo classification, nine cases (18.8%) had higher-than-grade III postoperative complications and the most frequent complications were biliary complications. The CUSUM graph shows two peaks, at the 13th and 27th case. The multivariate analysis revealed that a body mass index ≥ 23 kg/m² and intraoperative cholangiography were the only factors that were independently associated with longer operation time. Based on these results, an RA-CUSUM analysis was performed to assess the learning curve, which showed a decrease in the learning curve after 33 to 34 PLDH procedures.

Conclusions

A learning curve effect was demonstrated in this study after 33 to 34 PLDH procedures. There are relatively many biliary complications, and it is necessary to further examine the method of bile duct transection.

Gagner MRM, Dubuc J (1992) Laparoscopic partial hepatectomy for liver tumor. Surg Endosc 6:99

Buell JF, Cherqui D, Geller DA et al (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830CrossRefPubMed

Hibi T, Cherqui D, Geller DA et al (2014) International survey on technical aspects of laparoscopic liver resection: a web-based study on the global diffusion of laparoscopic liver surgery prior to the 2nd international consensus conference on laparoscopic liver resection in Iwate, Japan. J Hepatobiliary Pancreat Sci 21:737–744CrossRefPubMed

Wakabayashi G, Cherqui D, Geller DA et al (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261:619–629PubMed

Ciria R, Cherqui D, Geller DA et al (2016) Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg 263:761–777CrossRefPubMed

Fretland ÅA, Dagenborg VJ, Bjørnelv GMW et al (2018) Laparoscopic versus open resection for colorectal liver metastases: the OSLO-COMET randomized controlled trial. Ann Surg 267:199–207CrossRefPubMed

Cherqui D, Soubrane O, Husson E et al (2002) Laparoscopic living donor hepatectomy for liver transplantation in children. Lancet 359:392–396CrossRefPubMed

Soubrane O, de Rougemont O, Kim KH et al (2015) Laparoscopic living donor left lateral sectionectomy: a new standard practice for donor hepatectomy. Ann Surg 262:757–761 (discussion 761-753)CrossRefPubMed

Hong SK, Lee KW, Choi Y et al (2018) Initial experience with purely laparoscopic living-donor right hepatectomy. Br J Surg 105:751–759CrossRefPubMed

10.

Suh KS, Hong SK, Lee KW et al (2018) Pure laparoscopic living donor hepatectomy: focus on 55 donors undergoing right hepatectomy. Am J Transplant 18:434–443CrossRefPubMed

11.

Kim KH, Kang SH, Jung DH et al (2017) Initial outcomes of pure laparoscopic living donor right hepatectomy in an experienced adult living donor liver transplant center. Transplantation 101:1106–1110CrossRefPubMed

12.

Rotellar F, Pardo F, Benito A et al (2017) Totally laparoscopic right hepatectomy for living donor liver transplantation: analysis of a preliminary experience on 5 consecutive cases. Transplantation 101:548–554CrossRefPubMed

13.

Hong SK, Suh KS, Yoon KC et al (2019) The learning curve in pure laparoscopic donor right hepatectomy: a cumulative sum analysis. Surg Endosc 33:3741–3748CrossRefPubMed

14.

Broering DC, Berardi G, El Sheikh Y et al (2020) Learning curve under proctorship of pure laparoscopic living donor left lateral sectionectomy for pediatric transplantation. Ann Surg 271:542–548CrossRefPubMed

15.

Yap CH, Colson ME, Watters DA (2007) Cumulative sum techniques for surgeons: a brief review. ANZ J Surg 77:583–586CrossRefPubMed

16.

Steiner SH, Cook RJ, Farewell VT et al (2000) Monitoring surgical performance using risk-adjusted cumulative sum charts. Biostatistics 1:441–452CrossRefPubMed

17.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral

18.

Takahara T, Wakabayashi G, Hasegawa Y et al (2015) Minimally invasive donor hepatectomy: evolution from hybrid to pure laparoscopic techniques. Ann Surg 261:e3-4CrossRefPubMed

19.

Takahara T, Wakabayashi G, Nitta H et al (2017) The first comparative study of the perioperative outcomes between pure laparoscopic donor hepatectomy and laparoscopy-assisted donor hepatectomy in a single institution. Transplantation 101:1628–1636CrossRefPubMed

20.

Hasegawa Y, Nitta H, Takahara T et al (2019) Pure laparoscopic living donor hepatectomy using the Glissonean pedicle approach (with video). Surg Endosc 33:2704–2709CrossRefPubMed

21.

Hasegawa Y, Nitta H, Takahara T et al (2020) Anterior approach for pure laparoscopic donor right hepatectomy. Surg Endosc 34:4677–4678CrossRefPubMed

22.

Hasegawa Y, Nitta H, Takahara T et al (2021) Pure laparoscopic donor hepatectomy: right posterior section graft. J Gastrointest Surg 25:2718–2719CrossRefPubMed

23.

Choi M, Hwang HK, Lee WJ et al (2021) Total laparoscopic pancreaticoduodenectomy in patients with periampullary tumors: a learning curve analysis. Surg Endosc 35:2636–2644CrossRefPubMed

24.

Zheng-Yan L, Feng Q, Yan S et al (2021) Learning curve of robotic distal and total gastrectomy. Br J Surg 108:1126–1132CrossRefPubMed

25.

Rhu J, Choi GS, Kwon CHD et al (2020) Learning curve of laparoscopic living donor right hepatectomy. Br J Surg 107:278–288CrossRefPubMed

26.

Hasegawa Y, Nitta H, Takahara T et al (2017) Safely extending the indications of laparoscopic liver resection: when should we start laparoscopic major hepatectomy? Surg Endosc 31:309–316CrossRefPubMed

27.

Brown KM, Geller DA (2016) What is the learning curve for laparoscopic major hepatectomy? J Gastrointest Surg 20:1065–1071CrossRefPubMed

28.

Nomi T, Fuks D, Kawaguchi Y et al (2015) Learning curve for laparoscopic major hepatectomy. Br J Surg 102:796–804CrossRefPubMed

29.

Lee W, Woo JW, Lee JK et al (2016) Comparison of learning curves for major and minor laparoscopic liver resection. J Laparoendosc Adv Surg Tech A 26:457–464CrossRefPubMed

30.

van der Poel MJ, Besselink MG, Cipriani F et al (2016) Outcome and learning curve in 159 consecutive patients undergoing total laparoscopic hemihepatectomy. JAMA Surg 151:923–928CrossRefPubMed

31.

Umemura A, Nitta H, Takahara T et al (2023) Pure laparoscopic left lateral graft procurement with removing segment 3 employing Glissonean approach, indocyanine green fluorescence imaging and in situ splitting for a small infant. J Minim Access Surg 19:165–167CrossRefPubMed

32.

Safwan M, Nagai S, Collins K et al (2018) Impact of abdominal shape on living liver donor outcomes in mini-incision right hepatic lobectomy: comparison among 3 techniques. Liver Transpl 24:516–527CrossRefPubMed

33.

Nomi T, Fuks D, Ferraz JM et al (2015) Influence of body mass index on postoperative outcomes after laparoscopic liver resection. Surg Endosc 29:3647–3654CrossRefPubMed

34.

Uchida H, Iwashita Y, Saga K et al (2016) Benefit of laparoscopic liver resection in high body mass index patients. World J Gastroenterol 22:3015–3022CrossRefPubMedPubMedCentral

35.

Kwan B, Waters PS, Keogh C et al (2021) Body mass index and surgical outcomes in laparoscopic liver resections: a systematic review. ANZ J Surg 91:2296–2307CrossRefPubMed

36.

Hong SK, Tan MY, Worakitti L et al (2022) Pure laparoscopic versus open right hepatectomy in live liver donors: a propensity score-matched analysis. Ann Surg 275:e206–e212CrossRefPubMed

37.

Nitta H, Sasaki A, Fujita T et al (2010) Laparoscopy-assisted major liver resections employing a hanging technique: the original procedure. Ann Surg 251:450–453CrossRefPubMed

38.

Nitta H, Sasaki A, Katagiri H et al (2022) Is laparoscopic hepatectomy safe for giant liver tumors? Proposal from a single institution for totally laparoscopic hemihepatectomy using an anterior approach for giant liver tumors larger than 10 cm in diameter. Curr Oncol 29:8261–8268CrossRefPubMedPubMedCentral

Title: Risk-Adjusted Assessment of the Learning Curve for Pure Laparoscopic Donor Hepatectomy for Adult Recipients
Authors: Koji Kikuchi
Hiroyuki Nitta
Akira Umemura
Hirokatsu Katagiri
Shoji Kanno
Daiki Takeda
Taro Ando
Satoshi Amano
Akira Sasaki
Publication date: 16-06-2023
Publisher: Springer International Publishing
Keywords: Cholangiography
Laparotomy
Laparotomy
Published in: World Journal of Surgery / Issue 10/2023
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-023-07089-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk-Adjusted Assessment of the Learning Curve for Pure Laparoscopic Donor Hepatectomy for Adult Recipients

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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