title: Development Process and Technical Aspects of Laparoscopic Hepatectomy: Learning Curve Based on 15 Years of Experience.
abstract: BACKGROUND
  Laparoscopic hepatectomy continues to be a challenging operation associated with a steep learning curve. This study aimed to evaluate the learning process during 15 years of experience with laparoscopic hepatectomy and to identify approaches to standardization of this procedure.
  
  
  METHODS
  Prospectively collected data of 317 consecutive laparoscopic hepatectomies performed from January 2000 to December 2014 were reviewed retrospectively. The operative procedures were classified into 4 categories (minor hepatectomy, left lateral sectionectomy [LLS], left hepatectomy, and right hepatectomy), and indications were classified into 5 categories (benign-borderline tumor, living donor, metastatic liver tumor, biliary malignancy, and hepatocellular carcinoma).
  
  
  RESULTS
  During the first 10 years, the procedures were limited mainly to minor hepatectomy and LLS, and the indications were limited to benign-borderline tumor and living donor. Implementation of major hepatectomy rapidly increased the proportion of malignant tumors, especially hepatocellular carcinoma, starting from 2011. Conversion rates decreased with experience for LLS (13.3% vs 3.4%; p = 0.054) and left hepatectomy (50.0% vs 15.0%; p = 0.012), but not for right hepatectomy (41.4% vs 35.7%; p = 0.661).
  
  
  CONCLUSIONS
  Our 15-year experience clearly demonstrates the stepwise procedural evolution from LLS through left hepatectomy to right hepatectomy, as well as the trend in indications from benign-borderline tumor/living donor to malignant tumors. In contrast to LLS and left hepatectomy, a learning curve was not observed for right hepatectomy. The ongoing development process can contribute to faster standardization necessary for future advances in laparoscopic hepatectomy.
authors.affiliation: Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris Université Pierre et Marie Curie, Paris, France Department of Hepato-Pancreato-Biliary Surgery and Transplantation, Hopital Beaujon, Université Paris VII, Clichy Cedex, France.
authors.forename: Shohei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Olivier
authors.initials: O
authors.lastname: Scatton
authors.forename: Claire
authors.initials: C
authors.lastname: Goumard
authors.forename: Ailton
authors.initials: A
authors.lastname: Sepulveda
authors.forename: Raffaele
authors.initials: R
authors.lastname: Brustia
authors.forename: Fabiano
authors.initials: F
authors.lastname: Perdigao
authors.forename: Olivier
authors.initials: O
authors.lastname: Soubrane
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D010535:Laparoscopy; D059032:Learning Curve; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult