Marcel J van der Poel1, Floor Huisman2, Olivier R Busch2, Mohammad Abu Hilal3, Thomas M van Gulik2, Pieter J Tanis2, Marc G Besselink4. 1. Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.j.vanderpoel@amc.nl. 2. Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. 3. Hepatobiliary and Pancreatic Surgery Unit, Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK. 4. Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.g.besselink@amc.nl.
Abstract
BACKGROUND: Uncontrolled introduction of laparoscopic liver surgery (LLS) could compromise postoperative outcomes. A stepwise introduction of LLS combined with structured training is advised. This study aimed to evaluate the impact of such a stepwise introduction. METHODS: A retrospective, single-center case series assessing short term outcomes of all consecutive LLS in the period November 2006-January 2017. The technique was implemented in a stepwise fashion. To evaluate the impact of this stepwise approach combined with structured training, outcomes of LLS before and after a laparoscopic HPB fellowship were compared. RESULTS: A total of 135 laparoscopic resections were performed. Overall conversion rate was 4% (n = 5), clinically relevant complication rate 13% (n = 18) and mortality 0.7% (n = 1). A significant increase in patients with major LLS, multiple liver resections, previous abdominal surgery, malignancies and lesions located in posterior segments was observed after the fellowship as well as a decrease in the use of hand-assistance. Increasing complexity in the post fellowship period was reflected by an increase in operating times, but without comprising other surgical outcomes. CONCLUSION: A stepwise introduction of LLS combined with structured training reduced the clinical impact of the learning curve, thereby confirming guideline recommendations.
BACKGROUND: Uncontrolled introduction of laparoscopic liver surgery (LLS) could compromise postoperative outcomes. A stepwise introduction of LLS combined with structured training is advised. This study aimed to evaluate the impact of such a stepwise introduction. METHODS: A retrospective, single-center case series assessing short term outcomes of all consecutive LLS in the period November 2006-January 2017. The technique was implemented in a stepwise fashion. To evaluate the impact of this stepwise approach combined with structured training, outcomes of LLS before and after a laparoscopic HPB fellowship were compared. RESULTS: A total of 135 laparoscopic resections were performed. Overall conversion rate was 4% (n = 5), clinically relevant complication rate 13% (n = 18) and mortality 0.7% (n = 1). A significant increase in patients with major LLS, multiple liver resections, previous abdominal surgery, malignancies and lesions located in posterior segments was observed after the fellowship as well as a decrease in the use of hand-assistance. Increasing complexity in the post fellowship period was reflected by an increase in operating times, but without comprising other surgical outcomes. CONCLUSION: A stepwise introduction of LLS combined with structured training reduced the clinical impact of the learning curve, thereby confirming guideline recommendations.
Authors: Fadi Rassam; Pim B Olthof; Krijn P van Lienden; Roel J Bennink; Joris I Erdmann; Rutger-Jan Swijnenburg; Olivier R Busch; Marc G Besselink; Thomas M van Gulik Journal: Ann Transl Med Date: 2020-04