title: Donor hepatectomy for living donor liver transplantation: learning steps and surgical outcome.
abstract: OBJECTIVE
  Complications associated with live liver donor surgery should be minimized. There is little information on the impact of team experience and learning on the surgical outcome. The aim of this study was to clarify the impact of team experience in a single center on the outcome of live donor hepatectomy.
  
  
  METHODS
  Graft livers consisted of 56 right lobes, 40 left lobes with/without caudate, 36 left lateral section (LLS), and 11 right posterior section (RPS). Surgeries were divided according to the time of execution: era I (n=50), era II (n=50) and era III (n=43).
  
  
  RESULTS
  No postoperative mortality was recorded. Blood loss steadily decreased and operation time decreased after era II (P<0.0001). The overall frequency of postoperative morbidities by the Clavien system was significantly less for LLS graft [P=0.009, right lobe (42.9%) vs. LLS (13.9%)]. Multivariate risk factor analysis showed that donors in recent years were at low risk of morbidity and bile leakage (P=0.025 and 0.010, respectively). There was less impact for team experience on the outcome in LLS graft than other types of grafts.
  
  
  CONCLUSIONS
  Our analysis demonstrated several learning steps in live liver donor surgery and confirmed their positive impact on surgical outcome.
authors.affiliation: Department of Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, 565-0871, Osaka, Japan. smarubashi@gesurg.med.osaka-u.ac.jp
authors.forename: Shigeru
authors.initials: S
authors.lastname: Marubashi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nagano
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Wada
authors.forename: Shogo
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Eguchi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takeda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tanemura
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data; D005260:Female; D006498:Hepatectomy / Q000193:education* / Q000379:methods / Q000401:mortality; D006801:Humans; D016031:Liver Transplantation / Q000193:education* / Q000379:methods / Q000401:mortality; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D012307:Risk Factors; D020858:Tissue and Organ Harvesting / Q000193:education* / Q000379:methods; D016896:Treatment Outcome