Evaluating the learning curve for laparoscopic liver resection: a comparative study between standard and learning...

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgery
• Surgical Education

Background:

• Laparoscopic liver resection (LLR) demands expertise in both hepatobiliary surgery and advanced laparoscopy.
• Existing data on LLR learning curves primarily reflects pioneer surgeons' experiences.
• This study investigates the LLR learning curve for subsequent-generation surgeons.

Purpose of the Study:

• To evaluate the learning curve for laparoscopic liver resection (LLR) among second-generation surgeons.
• To compare the efficacy of different Cumulative Summation (CUSUM) methodologies, with and without risk adjustment, in defining the LLR learning curve.
• To assess the impact of risk adjustment using the Iwate index on the LLR learning curve.

Main Methods:

• A retrospective analysis of a prospective database of 111 consecutive LLR patients (2011-2016) was performed.
• Two surgeons' learning curves for minor hepatectomy (MH) were assessed using standard CUSUM, risk-adjusted CUSUM (Iwate index), and Learning Curve CUSUM (LC-CUSUM).
• Key endpoints included operative time and conversion rates.

Main Results:

• Standard CUSUM indicated a learning curve of 50-60 MH procedures.
• Risk-adjusted CUSUM reduced the learning curve to 25-30 MH procedures.
• LC-CUSUM identified an even shorter learning curve, ranging from 17-25 MH procedures.

Conclusions:

• The learning curve for laparoscopic minor liver resection is shorter for second-generation surgeons compared to pioneers.
• Hepatobiliary Pancreatic (HPB) fellowship programs may accelerate LLR proficiency and facilitate its safe expansion.
• The LC-CUSUM method presents a viable alternative for learning curve assessment and warrants further investigation.