Hepatobiliary surgical training in a changing educational landscape: An 18-year longitudinal analysis of a
Daniel Wettstein1, Florian Primavesi2, Omar Alkhatib3
1National Institute of Oncology, Budapest, Hungary.
Background:
Hepatobiliary (HB) surgery is increasingly complex, requiring expertise beyond general surgery training. Structured fellowship programmes aim to ensure adequate operative training, academic growth, and global leadership, but their outcomes are not well studied. The Liverpool Hepatobiliary Fellowship has provided international HB training in a high-volume centre in the United Kingdom for over 18 years.
Methods:
We performed a cross-sectional survey of all senior fellows who completed ≥6 months of the Liverpool fellowship (2007-2025). The questionnaire covered demographics, pre-fellowship experience, operative volume, academic productivity, and subjective fellowship evaluation. Fellows self-rated their confidence (1-10 scale) in performing a right hemihepatectomy with a junior assistant before and after the fellowship. Quantitative data were analysed descriptively, and pre-post confidence changes were tested. Qualitative responses were thematically analysed.
Results:
Eighteen of 22 eligible fellows (82%) completed the survey. Fellows reported a significant increase in operative confidence, measured subjectively as their confidence in performing a right hemihepatectomy with a junior assistant (median improvement: 2.5/10 to 9/10). Median case volume included 65 liver resections. Minimally invasive surgery (MIS) exposure increased from 10 cases overall at the beginning of the programme to over 20 in the last 5 years. Over 80% of fellows published during or after the fellowship, and 83% were appointed to consultant roles within one year. Qualitative responses emphasized strong mentorship, high case volume, and career-defining experiences. Gaps identified included robotic surgery exposure and structured academic support.
Conclusions:
Dedicated HB fellowship programmes significantly enhance surgical competence, operative autonomy, academic output, and leadership development. The Liverpool programme exemplifies a successful international training model, combining high-volume hands-on practice with strong mentorship. The recent incorporation of robotic-assisted surgery addresses an identified key training gap, ensuring the fellowship's continued relevance in a technologically advancing field.
