title: The single surgeon learning curve of laparoscopic liver resection: A continuous evolving process through stepwise difficulties.
abstract: The aim of the study was to evaluate the single-surgeon learning curve (SSLC) in laparoscopic liver surgery over an 11-year period with risk-adjusted (RA) cumulative sum control chart analysis.Laparoscopic liver resection (LLR) is a challenging and highly demanding procedure. No specific data are available for defining the feasibility and reproducibility of the SSLC regarding a consistent and consecutive caseload volume over a specified time period.A total of 319 LLR performed by a single surgeon between June 2003 and May 2014 were retrospectively analyzed. A difficulty scale (DS) ranging from 1 to 10 was created to rate the technical difficulty of each LLR. The risk-adjusted cumulative sum control chart (RA-CUSUM) analysis evaluated conversion rate (CR), operative time (OT) and blood loss (BL). Perioperative morbidity and mortality were also analyzed.The RA-CUSUM analysis of the DS identified 3 different periods: P1 (n = 91 cases), with a mean DS of 3.8; P2 (cases 92-159), with a mean DS of 5.3; and P3 (cases 160-319), with a mean DS of 4.7. P2 presented the highest conversion and morbidity rates with a longer OT, whereas P3 showed the best results (P < 0.001). Fifty cases were needed to achieve a significant decrease in BL. The overall morbidity rate was 13.8%; no perioperative mortality was observed.According to our analysis, at least 160 cases (P3) are needed to complete the SSLC performing safely different types of LLR. A minimum of 50 cases can provide a significant decrease in BL. Based on these findings, a longer learning curve should be anticipated to broaden the indications for LLR.
authors: Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital Medical School Bio Cell Statistics, Faculty of Ghent University, Belgium Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.
authors: Federico
authors: F
authors: Tomassini
authors: Vincenzo
authors: V
authors: Scuderi
authors: Roos
authors: R
authors: Colman
authors: Marco
authors: M
authors: Vivarelli
authors: Roberto
authors: R
authors: Montalti
authors: Roberto Ivan
authors: RI
authors: Troisi
mesh_terms: D002983:Clinical Competence; D004502:Education, Medical, Continuing; D005260:Female; D006498:Hepatectomy / Q000193:education*; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D008297:Male; D061646:Operative Time; D015203:Reproducibility of Results; D012189:Retrospective Studies; D066231:Surgeons / Q000193:education* / Q000592:standards