title: MILS in a general surgery unit: learning curve, indications, and limitations.
abstract: Minimally invasive liver surgery (MILS) is going to be a method with a wide diffusion even in general surgery units. Organization, learning curve effect, and the environment are crucial issues to evaluate before starting a program of minimally invasive liver resections. Analysis of a consecutive series of 70 patients has been used to define advantages and limits of starting a program of MILS in a general surgery unit. Seventeen MILS have been calculated with the cumulative sum method as the number of cases to complete the learning curve. Operative times [270 (60-480) vs. 180 (15-550) min; p 0.01] and rate of conversion (6/17 vs. 5/53; p 0.018) decrease after this number of cases. More complex cases can be managed after a proper optimization of all steps of liver resection. When a high confidence of the medical and nurse staff with MILS is reached, economical and strategic issues should be evaluated in order to establish a multidisciplinary hepatobiliary unit independent from the general surgery unit to manage more complex cases.
authors.affiliation: Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL Umbria 2, Ospedale San Matteo degli Infermi, Spoleto, Italy, albertopatriti@gmail.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Patriti
authors.forename: Luigi
authors.initials: L
authors.lastname: Marano
authors.forename: Luciano
authors.initials: L
authors.lastname: Casciola
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002983:Clinical Competence; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D013502:General Surgery / Q000458:organization & administration*; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006757:Hospital Units / Q000458:organization & administration; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000458:organization & administration; D061646:Operative Time; D011787:Quality of Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome