The ERAS protocol was implemented safely. Achieving certain targets was challenging. Non-medical causes remain a significant factor in delayed discharge following PD.
III). Presence of a learning curve effect was assessed with a risk adjusted cumulative sum (RA-CUSUM) analysis. Results: Out of a total of 531 consecutive laparoscopic liver resections, 159 patients (42% male, median age 64 years (IQR 51e73)), underwent total laparoscopic hemihepatectomy (105 right, 54 left), 72% (n = 110) for malignant lesions. Overall median operation time was 330 minutes (270e391) and median blood loss 500 ml (250e 925). Conversion to an open procedure occurred in 11% (n = 17) of patients. Clinically relevant complications occurred in 12% (n = 19) of patients, with 1% mortality (n = 2). Conversion rate and blood loss were the only variables significantly affected by experience. RA-CUSUM analysis found a learning curve for conversions of 19 laparoscopic hemihepatectomies. Conclusion: Total laparoscopic hemihepatectomy is a feasible and safe procedure with a learning curve of 19 procedures for conversions.
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