Learning Curve for Laparoscopic Major Hepatectomy: Use of the Cumulative Sum Method

Abstract

Laparoscopic major resection is safe and feasible; operative outcomes improved after overcoming the learning curve. Right posterior sectionectomy, however, should be further evaluated for its cost-effectiveness.

Development and validation of a difficulty score to predict intraoperative complications during laparoscopic liver resection

“…Grouping of scores into risk brackets was performed in order to guide surgeons through the learning curve. The learning curve for minor resections is between 20 and 60 procedures, whereas that for major resections is between 30 and 60 procedures. Therefore, those at the beginning of the learning curve (first 40 procedures) should be undertaking low‐risk procedures (score 0–2) before moving to moderate‐risk procedures (score 3–5) for the second part of the learning curve.…”

Comparative analysis of learning curve in complex robot-assisted and laparoscopic liver resection

“…16 Like in many other fields of surgery, various authors continue to use multiple different and separate factors, the dynamics of which should confirm the improvement of the manual skills of the surgeon in laparoscopic liver resection: operative time, pedicle clamping, number of major liver resection, rate of conversion, blood loss, morbidity, and others. [17][18][19] Some sophisticated statistical methods (CUSUM) applied for learning curve estimation also refer to surgical events. [19][20][21] The outcome of a surgical procedure depends not only upon surgical skill, but also on the complexity of surgery, which in turn is a resultant value of many composing factors.…”

“…[17][18][19] Some sophisticated statistical methods (CUSUM) applied for learning curve estimation also refer to surgical events. [19][20][21] The outcome of a surgical procedure depends not only upon surgical skill, but also on the complexity of surgery, which in turn is a resultant value of many composing factors. Therefore, it is difficult to compare learning curves for resections of varying complexity, and even more to compare learning curves of different clinics.…”

Standardization of operative technique in minimally invasive right hepatectomy: improving cost-value relationship through value stream mapping in hepatobiliary surgery

“…While laparoscopic major hepatectomy may have long learning curves there are models that can be used to quicken this process including both small and large animal models. 18 Additionally, the oft quoted figure of 20-30 19 index procedures to gain proficiency in such a procedure should not be a hard ask from the major hepatobiliary centers. Several studies have reported on equivalent outcomes with laparoscopic hepatectomy 20 however they are plagued with inconsistencies in inclusion criteria and tend to include all comers.…”