title: Validation of the laparoscopically stapled approach as a standard technique for left lateral segment liver resection.
abstract: BACKGROUND
  Left lateral sectionectomy (LLS) is the most common type of anatomic laparoscopic liver resection performed, accounting for 20 % of all laparoscopic hepatectomies. Because there has been no standardized surgical technique for laparoscopic left lateral sectionectomy (LLLS), we offer an established operation: laparoscopically stapled left lateral sectionectomy (LSLLS). Our aim was to perform a case-controlled study of LSLLS with traditional (without vascular staplers) laparoscopic left lateral sectionectomy (TLLLS), validating the standardization and reproducibility of LSLLS.
  
  
  METHODS
  From February 2009 to December 2011, a total of 49 LSLLSs were performed. The results were compared with 33 cohort-matched TLLLSs from an earlier time period. Ordered sample cluster analysis was used to determine the learning curve of LSLLS based on the operating time and blood loss.
  
  
  RESULTS
  All LSLLS were performed successfully. There were no conversions to laparotomy or hand-assisted laparoscopic resection. Two endoscopic linear staplers were used in each case. Despite a higher hospital cost ($10,892 ± $944 vs. $8,962 ± $943, p < 0.05), LSLLS compared favorably with TLLLS regarding operating time (103 ± 21 vs. 151 ± 32 min, p < 0.05) and blood loss (70.8 ± 41.6 vs. 173.3 ± 131.1 ml, p < 0.05). No specific complications related to laparoscopy were observed. Ordered sample cluster analysis demonstrated a learning curve of 18 cases for LSLLS.
  
  
  CONCLUSIONS
  This study demonstrates the standardization and reproducibility of LSLLS. We therefore propose LSLLS as the standard technique for lesions located in the left lateral section of the liver.
authors: Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan, China. wangxuedong301@163.com
authors: Xuedong
authors: X
authors: Wang
authors: Jianwei
authors: J
authors: Li
authors: Hongguang
authors: H
authors: Wang
authors: Ying
authors: Y
authors: Luo
authors: Wenbin
authors: W
authors: Ji
authors: Weidong
authors: W
authors: Duan
authors: Xuan
authors: X
authors: Zhang
authors: Sen
authors: S
authors: Guo
authors: Kesen
authors: K
authors: Xu
authors: Jiahong
authors: J
authors: Dong
authors: Shuguo
authors: S
authors: Zheng
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D002681:China; D016000:Cluster Analysis; D005260:Female; D006498:Hepatectomy / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D059032:Learning Curve; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D061646:Operative Time; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013528:Surgical Staplers / Q000191:economics; D017792:Surgical Stapling / Q000191:economics / Q000295:instrumentation; D016896:Treatment Outcome