MILS in a general surgery unit: learning curve, indications, and limitations

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Techniques
• Surgical Education

Background:

• Minimally invasive liver surgery (MILS) adoption is increasing in general surgery units.
• Successful MILS implementation hinges on organization, learning curve management, and environmental factors.
• Evaluating MILS program initiation requires analyzing advantages and limitations.

Purpose of the Study:

• To define the advantages and limitations of initiating a minimally invasive liver resection program within a general surgery unit.
• To identify the learning curve threshold for MILS proficiency.

Main Methods:

• Analysis of a consecutive series of 70 patients undergoing MILS.
• Utilizing the cumulative sum (CUSUM) method to determine the learning curve endpoint.
• Comparing operative times and conversion rates before and after the learning curve threshold.

Main Results:

• The learning curve for MILS in a general surgery setting was determined to be 17 cases using the CUSUM method.
• Significant reductions in operative times (p=0.01) and conversion rates (p=0.018) were observed after completing the learning curve.
• Increased proficiency allows for the management of more complex liver resections.

Conclusions:

• A learning curve of approximately 17 cases is necessary for surgeons to achieve proficiency in MILS within a general surgery unit.
• Post-learning curve improvements in operative time and conversion rates support MILS adoption.
• Establishing a dedicated multidisciplinary hepatobiliary unit is recommended for managing complex cases once MILS proficiency is achieved.