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Stepwise development of laparoscopic liver resection skill using rubber traction technique
Jonathan G Navarro1, Incheon Kang2, Seoung Yoon Rho2
1Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea; Division of Surgical Oncology, Department of Surgery, Vicente Sotto Memorial Medical Center, Cebu City, Cebu, Philippines.
Summary
Standardizing laparoscopic liver resection (LLR) techniques and using a stepwise training approach improves surgical outcomes. This strategy enhances patient safety by optimizing surgeon proficiency and reducing complications during LLR procedures.
Area of Science:
- Hepatobiliary Surgery
- Surgical Education
- Minimally Invasive Surgery
Background:
- Patient safety in surgery is paramount.
- Standardized techniques and stepwise training are crucial for complex procedures like laparoscopic liver resection (LLR).
- Evaluating the impact of standardized LLR on surgical outcomes is essential.
Purpose of the Study:
- To describe the effects of a stepwise training approach and standardized laparoscopic liver resection (LLR) on surgical outcomes.
- To assess the learning curve for surgeons performing LLR.
- To determine the impact on patient safety and procedural efficiency.
Main Methods:
- Retrospective review of 272 consecutive LLR cases (January 2009 - December 2017).
- Utilized risk-adjusted cumulative sum (RA-CUSUM) for surgical failures (conversion, transfusion, Clavien-Dindo grade ≥3).
- Employed CUSUM for operative time to identify optimal learning curve points.
Main Results:
- Complication rates, transfusion needs, and conversion rates remained stable across increasing procedure complexity.
- A learning curve of 21 cases was established for right hepatectomy after 53 minor LLR cases.
- Significant improvements in blood loss and operative time were observed post-learning curve, with specific case numbers for anterolateral (37th) and posterosuperior (31st) resections.
Conclusions:
- Standardization of surgical technique for LLR is effective.
- A stepwise training approach for surgeons performing LLR significantly improves surgical outcomes.
- Implementation of these strategies enhances patient safety and procedural efficiency in LLR.
