Minimally invasive liver surgery in a hepato-biliary unit: learning curve and indications

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgery
• Laparoscopic Surgery

Background:

• Operative indications and resection types are critical in minimally invasive liver surgery (MILS).
• Surgeons' experience should not dictate the fundamental indications for MILS.
• Defining MILS indications and learning curves is essential in high-volume centers.

Purpose of the Study:

• To define the indications for MILS.
• To evaluate the learning curve for MILS.
• To assess changes in MILS adoption over time in a high-volume hepatobiliary surgery unit.

Main Methods:

• Retrospective analysis of 993 liver resections performed between 2009 and 2014.
• Comparison of MILS rates during the first two and last two years of the study period.
• Analysis of indications for MILS, including benign and malignant diseases, and specific procedures like left lateral sectionectomy.

Main Results:

• MILS constituted 8.2% (81/993) of all liver resections.
• The proportion of MILS significantly increased over time (6.4% vs. 10.8%, p=0.042).
• MILS for malignant disease significantly increased (3.2% vs. 7.5%, p<0.001), while indications for benign disease and left lateral sectionectomies remained stable.
• Minimally invasive approach was used in 67.6% of left lateral sectionectomies.

Conclusions:

• The proportion of MILS significantly increased in a high-volume hepatobiliary surgery unit over the study period.
• This increase was achieved without altering surgical indications for benign liver disease or the types of resections performed.
• MILS adoption for malignant disease saw a significant rise, indicating expanding applicability.