Related Experiment Video
Updated: Aug 6, 2026
Laparoscopic Left Lateral Sectionectomy: Guided by the Ligamentum Teres Hepatis and the Umbilical Fissure Vein
Published on: September 27, 2024
Comparison of learning curve difference of laparoscopist according to controller type of flexible scope during
Sunghae Park1, Namkee Oh2, Jinsoo Rhu2
1Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Background:
In laparoscopic liver resection (LLR), a skilled scopist is essential for maintaining a clear operative view. We evaluated the scopist's expertise on surgical outcomes and whether the flexible scope controller type (conventional dual-lever versus joystick) influences the scopist's learning curve.
Methods:
We retrospectively reviewed LLRs performed by a single surgeon between December 2021 and March 2023. Patients with prior hepatectomy, Child-Pugh class B/C, concurrent extrahepatic abdominal surgery, or laparoscopic donor hepatectomy were excluded. Expert scopists (n = 2) had > 7 years of experience, whereas beginner scopists (n = 2) had < 6 months. Outcomes were compared by expertise and scope type. Learning curves were assessed using linear regression and CUSUM analysis of operative time over case sequence.
Results:
Among 161 LLRs, 82 were performed with expert scopists and 79 with beginner scopists. Compared with the expert group, the beginner group had longer operative time (178.0 vs 139.5 min, p < 0.001), more intraoperative transfusions (8.9% vs 0%, p = 0.006), and a higher open conversion rate (6.3% vs 0%, p = 0.012). In 116 procedures using conventional scopes (experts, n = 57; beginners, n = 59), experts had shorter operative time (144.0 vs 178.0 min, p = 0.002) and fewer transfusions (0% vs 11.9%, p = 0.013). In 45 procedures using joystick scopes, operative time and transfusion rates did not differ significantly between expert and beginner scopists. In major hepatectomy, both groups showed decreasing operative time with joystick scopes. In minor hepatectomy, experts had shorter operative time with conventional scopes, whereas no significant difference was observed with joystick scopes.
Conclusion:
This study demonstrated that the proficiency of laparoscopists can affect surgical outcomes. Moreover, newly learning laparoscopists may acquire proficiency more rapidly when using joystick-controlled laparoscopes compared to conventional ones. In procedures like minor hepatectomy, which are relatively simpler, it was confirmed that there is no significant difference in proficiency when compared to expert scopists.
