Related Experiment Video
Updated: Apr 17, 2026
Laparoscopic Anatomic S7+S8d Resection Preserving Inferior Right Hepatic Vein and S6 with Right Hepatic Vein Transection
Published on: December 30, 2025
Detecting performance variance in complex surgical procedures: analysis of a step-wise technique for laparoscopic
Juan P Toro1, Ankit D Patel1, Nathaniel W Lytle1
1Department of Surgery, Emory Endosurgery and HPB Surgery Units, Emory University, Atlanta, GA, USA.
Background:
Laparoscopic right hepatectomy (LRH) is a technically challenging operation. Our aim is to evaluate a standardized technique of LRH and determine variances in performance.
Methods:
The procedure was deconstructed into 7 major step-wise components. All LRH followed the same surgical sequence, and used the same devices and operating room set-up. Thirty randomly selected video recordings of the procedure underwent intraoperative time analysis. The variances measured by standard deviation of each step were calculated (mean in minutes ± standard deviation).
Results:
Mean total operative time was 114 ± 25 min. The steps with the least variance were inferior vena cava dissection (8 ± 3) and right hepatic vein ligation (9 ± 5). The longest and also the step with the greatest variance was parenchymal transection (35 ± 12).
Conclusions:
LRH can be performed consistently using a standardized step-wise technique. Parenchymal transection had most variation, and this could be explained by intrinsic liver factors. Surgical performance improvement should begin with deconstructing the operation into definable steps to identify areas for change.
