Assessment of Learning Curve for Laparoscopic Liver Resection in Low-Volume Center
Taesombat W, MD¹, Nonthasoot B, MD¹, Sutherasan M, MD¹, Vorasittha A, MD¹, Sirichindakul B, MD¹
Affiliation : ¹ Department of Surgery, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
Background: Laparoscopic liver resection (LLR) is considered as alternative procedure to open liver resection. However, the
laparoscopic approach requires advanced laparoscopic skill. Most studies were limited to high-volume specialized center.
Objective: To assess the learning curve for LLR in low-volume center.
Materials and Methods: Between July 2008 and June 2015, all patients that underwent LLR were included. The effect of learning curve was evaluated by comparing peri-operative outcomes of LLR between two periods, the early versus the late group.
Results: Nine hundred sixty patients underwent liver resection and 67 patients (7%) had laparoscopic approach. Peri-operative outcomes of the early 30 patients were compared to the late 37 patients. The proportion of patients who had laparoscopic approach was not different between the two periods (early 7.2% versus late 6.8%). Most procedures were minor liver resection. Complication rate was significantly lower in the late group. Most common complication in the early group was bile leakage. There were no differences in operative time, blood loss, blood transfusion, conversion rate, length of stay, and number of positive resected margin.
Conclusion: The learning curve for LLR in low-volume liver center may require more patients. These results suggested that the learning curve required a minimum of 30 patients.
Received 11 Sep 2019 | Revised 6 Nov 2019 | Accepted 8 Nov 2019
Keywords : Laparoscopic liver resection, Learning curve, Low-volume center
