The Learning Curve For Laparoscopic Major Hepatectomy

Objective:In the period of rapid development of laparoscopic liver surgery,our center and team,to explore the learning curve of laparoscopic major hepatectomy through analyzing the changes of operation time,blood loss and conversion during laparoscopic surgery;intended to find a "threshold" of acquiring laparoscopy.It is conducive to further promote laparoscopic liver surgery.The laparoscopic surgery not only can reduce patients' suffering,but also shorten their length of stay in hospital.It is a great improvement to their life quality.Methods:our center and team has completed more than 1000 cases of laparoscopic liver resections since 1998,a large amount of data can be used to explore the learning curve for laparoscopic hepatectomy.A total of 210 laparoscopic right and left hepatectomies were included.The conversion to laparotomy is 33.All experimental data include preoperative characteristics,operating time,type of hepatectomy,intraoperative complications,blood loss and transfusions,postoperative morbidity and mortality,length of stay and so on.The CUSUM technique and moving average were used when data on duration of surgery,blood loss,conversion to laparotomy and length of stay were available.Results:According to the moving average of operation time and bloodloss,50 and 120 is regarded as cut-off point.Compared to another phase,the phase 3 was significant statistical difference in age,pathology,previous abdominal surgery and liver cirrhosis aspects.The phase 2 of the bloodloss and operation time(182.0±52.1)is the most stable and significant difference.There were no significant differences in the length of stay and conversion rate.The postoperative complication and conversion rate were 23%and 15.7 respectively.The learning curve for laparoscopic major hepatectomy shows that our center can already manage the techniques,applying some useful tricks to reduce blood loss during parenchymal transection.The learning curve has reached a plateau after 52 cases of left hepatectomy and 24 cases right hemi-hepatectomy,respectively.But learning curve of right hemi-hepatectomy remains to explore.Conclusion:The learning curve for laparoscopic major hepatectomy have completed through assessing CUSUMOT,MA and the cumulative sum of conversion to laparotomy.Learning curve in left hemi-hepatectomy need 52 cases.After completing learning curve for left hemi-hepatectomy,right hepatecomy is further to perform 10 cases or complete 24 cases synergy between left and right hemi-hepatectomy.The plateau which is representing increased competence with laparoscopic right hepatectomy remains to explore.For beginners,simple and small partial hepatectomy should be regarded as the best starting point.The"idealized" learning curve would not adequately describe the learning process for a complex laparoscopic hepatectomy.