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The single surgeon learning curve of laparoscopic liver resection : a continuous evolving process through stepwise difficulties

(2016) MEDICINE. 95(43).
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Abstract
The aim of the study was to evaluate the single-surgeon learning curve (SSLC) in laparoscopic liver surgery over an 11-year period with risk-adjusted (RA) cumulative sum control chart analysis.Laparoscopic liver resection (LLR) is a challenging and highly demanding procedure. No specific data are available for defining the feasibility and reproducibility of the SSLC regarding a consistent and consecutive caseload volume over a specified time period.A total of 319 LLR performed by a single surgeon between June 2003 and May 2014 were retrospectively analyzed. A difficulty scale (DS) ranging from 1 to 10 was created to rate the technical difficulty of each LLR. The risk-adjusted cumulative sum control chart (RA-CUSUM) analysis evaluated conversion rate (CR), operative time (OT) and blood loss (BL). Perioperative morbidity and mortality were also analyzed.The RA-CUSUM analysis of the DS identified 3 different periods: P1 (n = 91 cases), with a mean DS of 3.8; P2 (cases 92-159), with a mean DS of 5.3; and P3 (cases 160-319), with a mean DS of 4.7. P2 presented the highest conversion and morbidity rates with a longer OT, whereas P3 showed the best results (P<0.001). Fifty cases were needed to achieve a significant decrease in BL. The overall morbidity rate was 13.8%; no perioperative mortality was observed.According to our analysis, at least 160 cases (P3) are needed to complete the SSLC performing safely different types of LLR. A minimum of 50 cases can provide a significant decrease in BL. Based on these findings, a longer learning curve should be anticipated to broaden the indications for LLR.
Keywords
Conversion rate, Laparoscopic learning curve, Laparoscopic liver resection, Laparoscopic liver surgery, Risk-adjusted CUSUM analysis, LEFT LATERAL SECTIONECTOMY, RIGHT HEPATECTOMY, HEPATIC VEINS, EXPERIENCE, MANEUVER, TUMORS

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MLA
Tomassini, Federico, et al. “The Single Surgeon Learning Curve of Laparoscopic Liver Resection : A Continuous Evolving Process through Stepwise Difficulties.” MEDICINE, vol. 95, no. 43, 2016, doi:10.1097/md.0000000000005138.
APA
Tomassini, F., SCUDERI, V., Colman, R., Vivarelli, M., Montalti, R., & Troisi, R. (2016). The single surgeon learning curve of laparoscopic liver resection : a continuous evolving process through stepwise difficulties. MEDICINE, 95(43). https://doi.org/10.1097/md.0000000000005138
Chicago author-date
Tomassini, Federico, VINCENZO SCUDERI, Roos Colman, Marco Vivarelli, Roberto Montalti, and Roberto Troisi. 2016. “The Single Surgeon Learning Curve of Laparoscopic Liver Resection : A Continuous Evolving Process through Stepwise Difficulties.” MEDICINE 95 (43). https://doi.org/10.1097/md.0000000000005138.
Chicago author-date (all authors)
Tomassini, Federico, VINCENZO SCUDERI, Roos Colman, Marco Vivarelli, Roberto Montalti, and Roberto Troisi. 2016. “The Single Surgeon Learning Curve of Laparoscopic Liver Resection : A Continuous Evolving Process through Stepwise Difficulties.” MEDICINE 95 (43). doi:10.1097/md.0000000000005138.
Vancouver
1.
Tomassini F, SCUDERI V, Colman R, Vivarelli M, Montalti R, Troisi R. The single surgeon learning curve of laparoscopic liver resection : a continuous evolving process through stepwise difficulties. MEDICINE. 2016;95(43).
IEEE
[1]
F. Tomassini, V. SCUDERI, R. Colman, M. Vivarelli, R. Montalti, and R. Troisi, “The single surgeon learning curve of laparoscopic liver resection : a continuous evolving process through stepwise difficulties,” MEDICINE, vol. 95, no. 43, 2016.
@article{8509390,
  abstract     = {{The aim of the study was to evaluate the single-surgeon learning curve (SSLC) in laparoscopic liver surgery over an 11-year period with risk-adjusted (RA) cumulative sum control chart analysis.Laparoscopic liver resection (LLR) is a challenging and highly demanding procedure. No specific data are available for defining the feasibility and reproducibility of the SSLC regarding a consistent and consecutive caseload volume over a specified time period.A total of 319 LLR performed by a single surgeon between June 2003 and May 2014 were retrospectively analyzed. A difficulty scale (DS) ranging from 1 to 10 was created to rate the technical difficulty of each LLR. The risk-adjusted cumulative sum control chart (RA-CUSUM) analysis evaluated conversion rate (CR), operative time (OT) and blood loss (BL). Perioperative morbidity and mortality were also analyzed.The RA-CUSUM analysis of the DS identified 3 different periods: P1 (n = 91 cases), with a mean DS of 3.8; P2 (cases 92-159), with a mean DS of 5.3; and P3 (cases 160-319), with a mean DS of 4.7. P2 presented the highest conversion and morbidity rates with a longer OT, whereas P3 showed the best results (P<0.001). Fifty cases were needed to achieve a significant decrease in BL. The overall morbidity rate was 13.8%; no perioperative mortality was observed.According to our analysis, at least 160 cases (P3) are needed to complete the SSLC performing safely different types of LLR. A minimum of 50 cases can provide a significant decrease in BL. Based on these findings, a longer learning curve should be anticipated to broaden the indications for LLR.}},
  articleno    = {{e5138}},
  author       = {{Tomassini, Federico and SCUDERI, VINCENZO and Colman, Roos and Vivarelli, Marco and Montalti, Roberto and Troisi, Roberto}},
  issn         = {{0025-7974}},
  journal      = {{MEDICINE}},
  keywords     = {{Conversion rate,Laparoscopic learning curve,Laparoscopic liver resection,Laparoscopic liver surgery,Risk-adjusted CUSUM analysis,LEFT LATERAL SECTIONECTOMY,RIGHT HEPATECTOMY,HEPATIC VEINS,EXPERIENCE,MANEUVER,TUMORS}},
  language     = {{eng}},
  number       = {{43}},
  pages        = {{8}},
  title        = {{The single surgeon learning curve of laparoscopic liver resection : a continuous evolving process through stepwise difficulties}},
  url          = {{http://dx.doi.org/10.1097/md.0000000000005138}},
  volume       = {{95}},
  year         = {{2016}},
}

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