Comparison of Learning Curves for Major and Minor Laparoscopic Liver Resection.
BACKGROUND
Because laparoscopic liver resection (LLR) has a steep learning curve, analyzing experience is important for trainees. Several authors have described the learning curve of LLR, without comparing the learning curves between major and minor LLR.


METHODS
Perioperative data were retrieved from the medical records of 170 consecutive patients who underwent LLR by a single surgeon at a tertiary hospital. Learning curves were generated and compared between major and minor LLR using cumulative sum control charts and the moving average.


RESULTS
Major and minor LLR was performed in 96 and 74 patients, respectively. The learning curves showed a steady state after case 50 for major LLR. Because of discordant results in minor LLR, subgroup analyses were performed, showing competency in LLR after cases 25 and 35 for left lateral sectionectomy and tumorectomy, respectively. Transfused red blood cell volume (0.6 versus 2.2 packs, P < .001) decreased after achievement of competence in major LLR. Blood loss exceeding 500 mL (odds ratio 2.395, 95% confidence interval 1.096-5.233, P = .028) was independently associated with LLR failure.


CONCLUSIONS
The number of cases required to accomplish LLR differed according to the extent of resection. Extensive blood loss was independently associated with LLR failure.
Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine , Jinju, Korea.
Woohyung
W
Lee
Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine , Jinju, Korea.
Jung-Woo
JW
Woo
Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine , Jinju, Korea.
Jin-Kwon
JK
Lee
Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine , Jinju, Korea.
Ji-Ho
JH
Park
Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine , Jinju, Korea.
Ju-Yeon
JY
Kim
Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine , Jinju, Korea.
Seung-Jin
SJ
Kwag
Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine , Jinju, Korea.
Taejin
T
Park
Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine , Jinju, Korea.
Sang-Ho
SH
Jeong
Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine , Jinju, Korea.
Young-Tae
YT
Ju
Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine , Jinju, Korea.
Eun-Jung
EJ
Jeong
Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine , Jinju, Korea.
Young-Joon
YJ
Lee
Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine , Jinju, Korea.
Sang-Kyung
SK
Choi
Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine , Jinju, Korea.
Soon-Chan
SC
Hong
Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine , Jinju, Korea.
Chi-Young
CY
Jeong
D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D006498:Hepatectomy / Q000193:education* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000379:methods*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D056910:Republic of Korea