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Updated: Jun 30, 2026
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Laparoscopic Anatomical Right Hemihepatectomy via the In Situ Anterior Approach
Published on: August 8, 2025
Pure Laparoscopic Living Donor Right Hepatectomy: A Multifactorial Evolutional Learning Curve Analysis From a
Flavio Milana1,2, Sang Hoon Kim1, Alessandro Parente1,3,4
1Division of Hepatobiliary and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Journal of Hepato-Biliary-Pancreatic Sciences
|June 29, 2026
Summary
Mastering pure laparoscopic donor right hepatectomy (PLDRH) involves a non-linear learning curve. Technical standardization occurs around 60 cases, but full mastery, especially with complex anatomy, requires up to 180 cases.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Surgical Education
Background:
- Pure laparoscopic donor right hepatectomy (PLDRH) is a recognized safe procedure.
- The learning curve for PLDRH is often underestimated.
- Understanding the evolution of surgical skills is crucial for improving outcomes.
Purpose of the Study:
- To evaluate the learning curve patterns in pure laparoscopic donor right hepatectomy (PLDRH).
- To identify key variables influencing the mastery of PLDRH.
- To establish a data-driven approach for surgical coaching and training.
Main Methods:
- A consecutive series of 215 PLDRH cases from 2014-2021 were analyzed.
- Cumulative Sum (CUSUM) analysis assessed a composite score of graft weight, bile duct anatomy, operative time, and warm ischemia time.
- Segmented regression identified the learning curve breakpoint.
Main Results:
- No conversions to open surgery occurred; major complications were rare (0.9%).
- A significant learning curve breakpoint was identified at 180 cases.
- While operative time and warm ischemia time improved early (around 60 cases), increasing graft weight and bile duct complexity prolonged the learning process until case 180.
Conclusions:
- The PLDRH learning curve is multifactorial and non-linear, extending beyond initial technical standardization.
- Approximately 60 cases are needed for basic technical proficiency.
- Full mastery, particularly for complex cases, is achieved around 180 cases, highlighting the need for continued training and caution.
