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01-08-2016

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

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

Published in: Surgical Endoscopy | Issue 8/2016

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.

Azagra JS, Goergen M, Gilbart E, Jacobs D (1996) Laparoscopic anatomical (hepatic) left lateral segmentectomy-technical aspects. Surg Endosc 10(7):758–761CrossRefPubMed

Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection-2804 patients. Ann Surg 250(5):831–841CrossRefPubMed

Viganò L, Tayar C, Laurent A, Cherqui D (2009) Laparoscopic liver resection: a systematic review. J Hepatobiliary Pancreat Surg 16(4):410–421CrossRefPubMed

Reddy SK, Tsung A, Geller A (2011) Laparoscopic liver resection. World J Surg 35:1478–1486CrossRefPubMed

Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS, World Consensus Conference on Laparoscopic Surgery (2009) The international position on laparoscopic liver surgery: the Louisville statement, 2008. Ann Surg 250(5):825–830CrossRefPubMed

Chang S, Laurent A, Tayar C, Karoui M, Cherqui D (2007) Laparoscopy as a routine approach for left lateral sectionectomy. Br J Surg 94:58–63CrossRefPubMed

Aldrighetti L, Pulitanò C, Catena M, Arru M, Guzzetti E, Casati M, Comotti L, Ferla G (2008) A prospective evaluation of laparoscopic versus open left lateral hepatic sectionectomy. J Gastrointest Surg 12:457–462CrossRefPubMed

Abu Hilal M, Di Fabio F, Syed S, Wiltshire R, Dimovska E, Turner D, Primrose JN, Pearce NW (2013) Assessment of the financial implications for laparoscopic liver surgery: a single-centre UK cost analysis for minor and major hepatectomy. Surg Endosc 27(7):2542–2550CrossRefPubMed

Azagra JS, Goergen M, Brondello S, Calmes MO, Philippe P, Schmitz B (2009) Laparoscopic liver sectionectomy 2 and 3 (LLS 2 and 3): towards the “gold standard”. J Hepatobiliary Pancreat Surg 16:422–426CrossRefPubMed

10.

Vigano L, Laurent A, Tayar C, Tomatis M, Ponti A, Cherqui D (2009) The learning curve in laparoscopic liver resection. Improved feasibility and reproducibility. Ann Surg 250:772–782CrossRefPubMed

11.

Troisi RI, Van Huysse J, Berrevoet F, Vandenbossche B, Sainz-Barriga M, Vinci A, Ricciardi S, Bocchetti T, Rogiers X, de Hemptinne B (2011) Evolution of laparoscopic left lateral sectionectomy without the Pringle maneuver: through resection of benign and malignant tumors to living liver donation. Surg Endosc 25:79–87CrossRefPubMed

12.

Kluger MD, Vigano L, Barroso R, Cherqui D (2013) The learning curve in laparoscopic major liver resection. J Hepatobiliary Pancreat Sci 20(2):131–136CrossRefPubMed

13.

Hasegawa Y, Nitta H, Sasaki A, Takahara T, Ito N, Fujita T, Kanno S, Nishizuka S, Wakabayashi G (2013) Laparoscopic left lateral sectionectomy as a training procedure for surgeons learning laparoscopic hepatectomy. J Hepatobiliary Pancreat Sci 20(5):525–530CrossRefPubMed

14.

Abu Hilal M, Pearce NW (2008) Laparoscopic left lateral liver sectionectomy: a safe, efficient, reproducible technique. Dig Surg 25(4):305–308CrossRefPubMed

15.

Terminology Committee of the International Hepato-Pancreato-Biliary Association (2000) The IHPBA Brisbane 2000 terminology of liver anatomy and resections. HPB Surg 2:333–339

16.

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-years experience. Ann Surg 250(2):187–196CrossRefPubMed

17.

Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schön MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection. A report from the second international consensus conference held in Morioka. Ann Surg 261(4):619–629PubMed

18.

Dokmak S, Raut V, Aussilhou B, Ftériche FS, Farges O, Sauvanet A, Belghiti J (2014) Laparoscopic left lateral resection is the gold standard for benign liver lesions: a case-control study. HPB (Oxford) 16(2):183–187CrossRef

19.

Soubrane O, Goumard C, Laurent A, Tranchart H, Truant S, Gayet B, Salloum C, Luc G, Dokmak S, Piardi T, Cherqui D, Dagher I, Boleslawski E, Vibert E, Sa Cunha A, Belghiti J, Pessaux P, Boelle PY, Scatton O (2014) Laparoscopic resection of hepatocellular carcinoma: a French survey in 351 patients. HPB (Oxford) 16(4):357–365CrossRef

20.

Abu Hilal M, McPhail MJ, Zeidan B, Zeidan S, Hallam MJ, Armstrong T, Primrose JN, Pearce NW (2008) Laparoscopic versus open left lateral hepatic sectionectomy: a comparative study. Eur J Surg Oncol 34(12):1285–1288CrossRefPubMed

21.

Fong ZV, Tanabe KK (2014) The clinical management of hepatocellular carcinoma in the United States, Europe and Asia: a comprehensive and evidence-based comparison and review. Cancer 120(18):2824–2838CrossRefPubMed

22.

Venook AP, Papandreou C, Furuse J, de Guevara LL (2010) The incidence and epidemiology of hepatocellular carcinoma: a global and regional perspective. Oncologist 15(Suppl 4):5–13CrossRefPubMed

23.

Zhou YM, Shao WY, Zhao YF, Xu DH, Li B (2011) Meta-analysis of laparoscopic versus open resection for hepatocellular carcinoma. Dig Dis Sci 56:1937–1943CrossRefPubMed

24.

Aldrighetti L, Guzzetti E, Pulitanò C, Cipriani F, Catena M, Paganelli M, Ferla G (2010) Case-matched analysis of totally laparoscopic versus open liver resection for HCC: short and middle term results. J Surg Oncol 102:82–86CrossRefPubMed

25.

Lesurtel M, Cherqui D, Laurent A, Tayar C, Fagniez PL (2003) Laparoscopic versus open left lateral hepatic lobectomy: a case-control study. J Am Coll Surg 196(2):236–242CrossRefPubMed

26.

Tang CN, Tai CK, Ha JP, Siu WT, Tsui KK, Li MK (2005) Laparoscopy versus open left lateral segmentectomy for recurrent pyogenic cholangitis. Surg Endosc 19(9):1232–1236CrossRefPubMed

27.

Soubrane O, Cherqui D, Scatton O, Stenard F, Bernard D, Branchereau S, Martelli H, Gauthier F (2006) Laparoscopic left lateral sectionectomy in living donors: safety and reproducibility of the technique in a single center. Ann Surg 244(5):815–820CrossRefPubMedPubMedCentral

28.

Pulitanò C, Aldrighetti L (2008) The current role of laparoscopic liver resection for the treatment of liver tumors. Nat Clin Pract Gastroenterol Hepatol 5:648–654CrossRefPubMed

29.

Aldrighetti L, Pulitanò C, Arru M, Catena M, Guzzetti E, Casati M, Ferla G (2008) Ultrasonic-mediated laparoscopic liver transection. Am J Surg 195:270–272CrossRefPubMed

Title: Learning curve of self-taught laparoscopic liver surgeons in left lateral sectionectomy: results from an international multi-institutional analysis on 245 cases
Authors: Francesca Ratti
Leonid I. Barkhatov
Federico Tomassini
Federica Cipriani
Airazat M. Kazaryan
Bjǿrn Edwin
Mohammad Abu Hilal
Roberto I. Troisi
Luca Aldrighetti
Publication date: 01-08-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 8/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4665-0

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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