Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 5/2016

01-05-2016 | Evidence-Based Current Surgical Practice

What is the Learning Curve for Laparoscopic Major Hepatectomy?

Authors: Kimberly M. Brown, David A. Geller

Published in: Journal of Gastrointestinal Surgery | Issue 5/2016

Login to get access

Abstract

Background

Laparoscopic liver resection is rapidly expanding with more than 9500 cases performed worldwide. While initial series reported non-anatomic resection of benign peripheral hepatic lesions, approximately 50–65 % of laparoscopic liver resections are now being done for malignant tumors, primarily hepatocellular carcinoma (HCC) or colorectal cancer liver metastases (mCRC).

Methods

We performed a literature review of published studies evaluating outcomes of major laparoscopic liver resection, defined as three or more Couinaud segments.

Results

Initial fears of adverse oncologic outcomes or tumor seeding have not been demonstrated, and dozens of studies have reported comparable 5-year disease-free and overall survival between laparoscopic and open resection of HCC or mCRC in case-cohort and propensity score-matched analyses. Increased experience has led to laparoscopic anatomic liver resections including laparoscopic major hepatectomy. A steep learning curve of 45–60 cases is evident for laparoscopic hepatic resection.

Conclusion

Laparoscopic major hepatectomy is safe and effective in the treatment of benign and malignant liver tumors when performed in specialized centers with dedicated teams. Comparable to other complex laparoscopic surgeries, laparoscopic major hepatectomy has a learning curve of 45–60 cases.
Literature
1.
Nguyen, K.T., T.C. Gamblin, and D.A. Geller, World review of laparoscopic liver resection-2,804 patients. Ann Surg, 2009. 250(5): p. 831–41.CrossRefPubMed
2.
Geller, D.A. and A. Tsung, Longterm outcomes and safety of laparoscopic liver resection surgery for hepatocellular carcinoma and metastatic colorectal cancer. J Hepatobiliary Pancreat Sci, 2015.
3.
Nguyen, K.T., T.C. Gamblin, and D.A. Geller, Laparoscopic liver resection for cancer. Future Oncol, 2008. 4(5): p. 661–70.CrossRefPubMed
4.
Nguyen, K.T. and D.A. Geller, Is laparoscopic liver resection safe and comparable to open liver resection for hepatocellular carcinoma? Ann Surg Oncol, 2009. 16(7): p. 1765–7.CrossRefPubMedPubMedCentral
5.
Nguyen, K.T., et al., Minimally invasive liver resection for metastatic colorectal cancer: a multi-institutional, international report of safety, feasibility, and early outcomes. Ann Surg, 2009. 250(5): p. 842–8.CrossRefPubMed
6.
Nguyen, K.T. and D.A. Geller, Outcomes of laparoscopic hepatic resection for colorectal cancer metastases. J Surg Oncol, 2010. 102(8): p. 975–7.CrossRefPubMed
7.
Reddy, S.K., A. Tsung, and D.A. Geller, Laparoscopic liver resection. World J Surg, 2011. 35(7): p. 1478–86.CrossRefPubMed
8.
Sasaki, A., et al., Ten-year experience of totally laparoscopic liver resection in a single institution. Br J Surg, 2009. 96(3): p. 274–9.CrossRefPubMed
9.
Vigano, L., et al., Laparoscopic liver resection: a systematic review. J Hepatobiliary Pancreat Surg, 2009. 16(4): p. 410–21.CrossRefPubMed
10.
Buell, J.F., et al., The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann Surg, 2009. 250(5): p. 825–30.CrossRefPubMed
11.
Wakabayashi, G., et al., Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg, 2015. 261(4): p. 619–29.PubMed
12.
Ciria, R., et al., Comparative short term benefits of laparoscopic liver resection: 9,000 cases and climbing. Ann Surg, 2015.
13.
Nguyen, K.T., et al., Comparative benefits of laparoscopic vs open hepatic resection: a critical appraisal. Arch Surg, 2011. 146(3): p. 348–56.CrossRefPubMed
14.
Castaing, D., et al., Oncologic results of laparoscopic versus open hepatectomy for colorectal liver metastases in two specialized centers. Ann Surg, 2009. 250(5): p. 849–55.CrossRefPubMed
15.
Kazaryan, A.M., et al., Laparoscopic resection of colorectal liver metastases: surgical and long-term oncologic outcome. Ann Surg, 2010. 252(6): p. 1005–12.CrossRefPubMed
16.
Kazaryan, A.M., B.I. Rosok, and B. Edwin, Laparoscopic and open liver resection for colorectal metastases: different indications? HPB (Oxford), 2010. 12(6): p. 434; author reply 435.CrossRef
17.
Topal, H., et al., Outcome of laparoscopic major liver resection for colorectal metastases. Surg Endosc, 2012. 26(9): p. 2451–5.CrossRefPubMed
18.
Schiffman, S.C., et al., Laparoscopic versus open liver resection for metastatic colorectal cancer: a metaanalysis of 610 patients. Surgery, 2015. 157(2): p. 211–22.CrossRefPubMed
19.
Beppu, T., et al., Long-term and perioperative outcomes of laparoscopic versus open liver resection for colorectal liver metastases with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Pancreat Sci, 2015.
20.
Takahara, T., et al., Minimally invasive donor hepatectomy: evolution from hybrid to pure laparoscopic techniques. Ann Surg, 2015. 261(1): p. e3-4.CrossRefPubMed
21.
Hasegawa, Y., et al., Approaches to laparoscopic liver resection: a meta-analysis of the role of hand-assisted laparoscopic surgery and the hybrid technique. J Hepatobiliary Pancreat Sci, 2015. 22(5): p. 335–41.CrossRefPubMed
22.
Cardinal, J.S., et al., Laparoscopic major hepatectomy: pure laparoscopic approach versus hand-assisted technique. J Hepatobiliary Pancreat Sci, 2013. 20(2): p. 114–9.CrossRefPubMedPubMedCentral
23.
Koffron, A.J., et al., Laparoscopic liver surgery for everyone: the hybrid method. Surgery, 2007. 142(4): p. 463–8; discussion 468 e1-2.CrossRef
24.
Nitta, H., et al., Laparoscopy-assisted major liver resections employing a hanging technique: the original procedure. Ann Surg, 2010. 251(3): p. 450–3.CrossRefPubMed
25.
Tsung, A., et al., Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg, 2014. 259(3): p. 549–55.CrossRefPubMed
26.
Nguyen, K.T. and D.A. Geller, Laparoscopic liver resection--current update. Surg Clin North Am, 2010. 90(4): p. 749–60.CrossRefPubMed
27.
Cherqui, D., et al., Laparoscopic living donor hepatectomy for liver transplantation in children. Lancet, 2002. 359(9304): p. 392–6.CrossRefPubMed
28.
Soubrane, O., et al., Laparoscopic left lateral sectionectomy in living donors: safety and reproducibility of the technique in a single center. Ann Surg, 2006. 244(5): p. 815–20.CrossRefPubMedPubMedCentral
29.
Ban, D., et al., A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci, 2014. 21(10): p. 745–53.CrossRefPubMed
30.
Giuliante, F. and F. Ardito, Minimally invasive liver surgery in a hepato-biliary unit: learning curve and indications. Updates Surg, 2015. 67(2): p. 201–6.CrossRefPubMed
31.
Nomi, T., et al., Learning curve for laparoscopic major hepatectomy. Br J Surg, 2015. 102(7): p. 796–804.CrossRefPubMed
32.
Hunter, J.G., J.M. Sackier, and G. Berci, Training in laparoscopic cholecystectomy. Quantifying the learning curve. Surg Endosc, 1994. 8(1): p. 28–31.CrossRefPubMed
33.
Andrew, C.G., et al., Early results after laparoscopic Roux-en-Y gastric bypass: effect of the learning curve. Can J Surg, 2006. 49(6): p. 417–21.PubMedPubMedCentral
34.
Bencini, L. and L.J. Sanchez, Learning curve for laparoscopic ventral hernia repair. Am J Surg, 2004. 187(3): p. 378–82.CrossRefPubMed
35.
Jaffer, U. and A.E. Cameron, Laparoscopic appendectomy: a junior trainee’s learning curve. JSLS, 2008. 12(3): p. 288–91.PubMedPubMedCentral
36.
Lal, P., et al., Laparoscopic total extraperitoneal (TEP) inguinal hernia repair: overcoming the learning curve. Surg Endosc, 2004. 18(4): p. 642–5.CrossRefPubMed
37.
Schlachta, C.M., et al., Defining a learning curve for laparoscopic colorectal resections. Dis Colon Rectum, 2001. 44(2): p. 217–22.CrossRefPubMed
38.
Vigano, L., et al., The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg, 2009. 250(5): p. 772–82.CrossRefPubMed
39.
Kluger, M.D., et al., The learning curve in laparoscopic major liver resection. J Hepatobiliary Pancreat Sci, 2013. 20(2): p. 131–6.CrossRefPubMed
40.
Abu Hilal, M., et al., Single-centre comparative study of laparoscopic versus open right hepatectomy. J Gastrointest Surg, 2011. 15(5): p. 818–23.CrossRefPubMed
41.
Dagher, I., et al., Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg, 2009. 250(5): p. 856–60.CrossRefPubMed
42.
Lin, N.C., H. Nitta, and G. Wakabayashi, Laparoscopic major hepatectomy: a systematic literature review and comparison of 3 techniques. Ann Surg, 2013. 257(2): p. 205–13.CrossRefPubMed
43.
Tzanis, D., et al., European experience of laparoscopic major hepatectomy. J Hepatobiliary Pancreat Sci, 2013. 20(2): p. 120–4.CrossRefPubMed
44.
Pearce, N.W., et al., Laparoscopic right hepatectomy: a challenging, but feasible, safe and efficient procedure. Am J Surg, 2011. 202(5): p. e52-8.CrossRefPubMed
45.
Alrasheed, T., et al., Robotic microsurgery: validating an assessment tool and plotting the learning curve. Plast Reconstr Surg, 2014. 134(4): p. 794–803.CrossRefPubMed
46.
Boone, B.A., et al., Assessment of quality outcomes for robotic pancreaticoduodenectomy: identification of the learning curve. JAMA Surg, 2015. 150(5): p. 416–22.CrossRefPubMed
47.
Napoli, N., et al., The learning curve in robotic distal pancreatectomy. Updates Surg, 2015.
48.
Park, E.J., et al., Is the learning curve of robotic low anterior resection shorter than laparoscopic low anterior resection for rectal cancer?: a comparative analysis of clinicopathologic outcomes between robotic and laparoscopic surgeries. Medicine (Baltimore), 2014. 93(25): p. e109.CrossRef
49.
Shakir, M., et al., The learning curve for robotic distal pancreatectomy: an analysis of outcomes of the first 100 consecutive cases at a high-volume pancreatic centre. HPB (Oxford), 2015. 17(7): p. 580–6.CrossRef
50.
Starnes, C.C., et al., The economy of motion of the totally robotic gastric bypass: technique, learning curve, and outcomes of a fellowship-trained, robotic bariatric surgeon. J Laparoendosc Adv Surg Tech A, 2015. 25(5): p. 411–8.CrossRefPubMed
Metadata
Title
What is the Learning Curve for Laparoscopic Major Hepatectomy?
Authors
Kimberly M. Brown
David A. Geller
Publication date
01-05-2016
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 5/2016
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-016-3100-8

Other articles of this Issue 5/2016

Journal of Gastrointestinal Surgery 5/2016 Go to the issue

Letter to the Editor

High Incidence of Redo Surgery After Frey Procedure for Chronic Pancreatitis in the Long-Term Follow-up

Original Article

The Oncological Value of Omentectomy in Gastrectomy for Cancer

Original Article

Proximal Roux-en-y Gastrojejunal Anastomosis with Pyloric Ring Resection Improves Gastric Emptying After Pancreaticoduodenectomy

Original Article

A Pilot Study Evaluating Serum MMP7 as a Preoperative Prognostic Marker for Pancreatic Ductal Adenocarcinoma Patients

Erratum

Erratum to: Impact Total Psoas Volume on Short- and Long-Term Outcomes in Patients Undergoing Curative Resection for Pancreatic Adenocarcinoma: a New Tool to Assess Sarcopenia

Original Article

Assessing the Costs Associated with Volume-Based Referral for Hepatic Surgery