title: Learning curve in laparoscopic liver surgery: a fellow's perspective.
abstract: The learning curve for laparoscopic liver surgery is infrequently addressed in current literature. In this paper, we explored the challenges faced in embarking on laparoscopic liver surgery in a unit that did predominantly open liver surgery. In setting up our laparoscopic liver surgery program, we adopted skills and practices learnt during fellowships at various high volume centers in North America and Australia, with modifications to suit our local patients' disease patterns. We started with simple minor resections in anterolateral segments to build confidence, which allowed us to train the surgical and nursing team before progressing to more difficult resections. Inter institutional collaboration and exchange of skills also enabled the synergistic development of techniques for safe progression to more complex surgeries. Multimedia resources and international guidelines for laparoscopic liver surgery are increasingly accessible, which further guide the practice of this emerging field, as evidence continues to validate the laparoscopic approach in well selected cases.
authors.affiliation: 1 Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore ; 2 Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
authors.forename: Adrian Kah Heng
authors.initials: AK
authors.lastname: Chiow
authors.affiliation: 1 Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore ; 2 Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
authors.forename: Ser Yee
authors.initials: SY
authors.lastname: Lee
authors.affiliation: 1 Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore ; 2 Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
authors.forename: Chung Yip
authors.initials: CY
authors.lastname: Chan
authors.affiliation: 1 Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore ; 2 Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
authors.forename: Siong San
authors.initials: SS
authors.lastname: Tan
keywords: Colorectal liver metastases; hepatocellular carcinoma (HCC); laparoscopic liver resection (LLR); learning curve; liver cancer