Brian K P Goh1,2, Jin-Yao Teo3,4, Ser-Yee Lee3,4, Juinn-Huar Kam3,4, Peng-Chung Cheow3,4, Premaraj Jeyaraj3,4, Pierce K H Chow3,4, London L P J Ooi3,4, Alexander Y F Chung3,4, Chung-Yip Chan3,4. 1. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Level 5, 20 College Road, Academia, Singapore, 169856, Singapore. bsgkp@hotmail.com. 2. Duke-National University of Singapore Medical School, Singapore, Singapore. bsgkp@hotmail.com. 3. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Level 5, 20 College Road, Academia, Singapore, 169856, Singapore. 4. Duke-National University of Singapore Medical School, Singapore, Singapore.
Abstract
BACKGROUND: Most studies analyzing the learning experience of laparoscopic liver resection (LLR) focused on the experience of one or two expert pioneering surgeons. This study aims to critically analyze the impact of individual surgeon experience on the outcomes of LLR based on the contemporary collective experiences of multiple surgeons at single institution. METHODS: Retrospective review of 324 consecutive LLR from 2006 to 2016. The cases were performed by 10 surgeons over various time periods. Four surgeons had individual experience with <20 cases, four surgeons with 20-30 cases, and two surgeons with >90 cases. The cohort was divided into two groups: comparing a surgeon's experience between the first 20, 30, 40, and 50 cases with patients treated thereafter. Similarly, we performed subset analyses for anterolateral lesions, posterosuperior lesions, and major hepatectomies. RESULTS: As individual surgeons gained increasing experience, this was significantly associated with older patients being operated, decreased hand-assistance, larger tumor size, increased liver resections, increased major resections, and increased resections of tumors located at the posterosuperior segments. This resulted in significantly longer operation time and increased use of Pringle maneuver but no difference in other outcomes. Analysis of LLR for tumors in the posterosuperior segments demonstrated that there was a significant decrease in conversion rates after a surgeon had experience with 20 LLR. For major hepatectomies, there was a significant decrease in morbidity, mortality, and length of stay after acquiring experience with 20 LLR. CONCLUSION: LLR can be safely adopted today especially for lesions in the anterolateral segments. LLR for lesions in the difficult posterosuperior segments and major hepatectomies especially in cirrhosis should only be attempted by surgeons who have acquired a minimum experience with 20 LLR.
BACKGROUND: Most studies analyzing the learning experience of laparoscopic liver resection (LLR) focused on the experience of one or two expert pioneering surgeons. This study aims to critically analyze the impact of individual surgeon experience on the outcomes of LLR based on the contemporary collective experiences of multiple surgeons at single institution. METHODS: Retrospective review of 324 consecutive LLR from 2006 to 2016. The cases were performed by 10 surgeons over various time periods. Four surgeons had individual experience with <20 cases, four surgeons with 20-30 cases, and two surgeons with >90 cases. The cohort was divided into two groups: comparing a surgeon's experience between the first 20, 30, 40, and 50 cases with patients treated thereafter. Similarly, we performed subset analyses for anterolateral lesions, posterosuperior lesions, and major hepatectomies. RESULTS: As individual surgeons gained increasing experience, this was significantly associated with older patients being operated, decreased hand-assistance, larger tumor size, increased liver resections, increased major resections, and increased resections of tumors located at the posterosuperior segments. This resulted in significantly longer operation time and increased use of Pringle maneuver but no difference in other outcomes. Analysis of LLR for tumors in the posterosuperior segments demonstrated that there was a significant decrease in conversion rates after a surgeon had experience with 20 LLR. For major hepatectomies, there was a significant decrease in morbidity, mortality, and length of stay after acquiring experience with 20 LLR. CONCLUSION: LLR can be safely adopted today especially for lesions in the anterolateral segments. LLR for lesions in the difficult posterosuperior segments and major hepatectomies especially in cirrhosis should only be attempted by surgeons who have acquired a minimum experience with 20 LLR.
Authors: Ibrahim Dagher; Brice Gayet; Dimitrios Tzanis; Hadrien Tranchart; David Fuks; Olivier Soubrane; Ho-Seong Han; Ki-Hun Kim; Daniel Cherqui; Nicholas O'Rourke; Roberto I Troisi; Luca Aldrighetti; Edwin Bjorn; Mohammed Abu Hilal; Giulio Belli; Hironori Kaneko; William R Jarnagin; Charles Lin; Juan Pekolj; Joseph F Buell; Go Wakabayashi Journal: J Hepatobiliary Pancreat Sci Date: 2014-08-06 Impact factor: 7.027
Authors: Brian K P Goh; Chung-Yip Chan; Jen-San Wong; Ser-Yee Lee; Victor T W Lee; Peng-Chung Cheow; Pierce K H Chow; London L P J Ooi; Alexander Y F Chung Journal: Surg Endosc Date: 2014-11-27 Impact factor: 4.584
Authors: Jin Yao Teo; Juinn Huar Kam; Chung Yip Chan; Brian K P Goh; Jen-San Wong; Victor T W Lee; Peng Chung Cheow; Pierce K H Chow; London L P J Ooi; Alexander Y F Chung; Ser Yee Lee Journal: Hepatobiliary Surg Nutr Date: 2015-12 Impact factor: 7.293
Authors: Joseph F Buell; Daniel Cherqui; David A Geller; Nicholas O'Rourke; David Iannitti; Ibrahim Dagher; Alan J Koffron; Mark Thomas; Brice Gayet; Ho Seong Han; Go Wakabayashi; Giulio Belli; Hironori Kaneko; Chen-Guo Ker; Olivier Scatton; Alexis Laurent; Eddie K Abdalla; Prosanto Chaudhury; Erik Dutson; Clark Gamblin; Michael D'Angelica; David Nagorney; Giuliano Testa; Daniel Labow; Derrik Manas; Ronnie T Poon; Heidi Nelson; Robert Martin; Bryan Clary; Wright C Pinson; John Martinie; Jean-Nicolas Vauthey; Robert Goldstein; Sasan Roayaie; David Barlet; Joseph Espat; Michael Abecassis; Myrddin Rees; Yuman Fong; Kelly M McMasters; Christoph Broelsch; Ron Busuttil; Jacques Belghiti; Steven Strasberg; Ravi S Chari Journal: Ann Surg Date: 2009-11 Impact factor: 12.969
Authors: Juinn Huar Kam; Brian Kp Goh; Chung-Yip Chan; Jen-San Wong; Ser-Yee Lee; Peng-Chung Cheow; Alexander Y F Chung; London L P J Ooi Journal: Singapore Med J Date: 2016-02-04 Impact factor: 1.858
Authors: Brian K P Goh; Nicholas Syn; Jin-Yao Teo; Yu-Xin Guo; Ser-Yee Lee; Peng-Chung Cheow; Pierce K H Chow; London L P J Ooi; Alexander Y F Chung; Chung-Yip Chan Journal: World J Surg Date: 2019-03 Impact factor: 3.352
Authors: Brian K P Goh; Darren Chua; Nicholas Syn; Jin-Yao Teo; Chung-Yip Chan; Ser-Yee Lee; Prema Raj Jeyaraj; Peng-Chung Cheow; Pierce K H Chow; London L P J Ooi; Alexander Y F Chung Journal: World J Surg Date: 2018-12 Impact factor: 3.352
Authors: Ye-Xin Koh; Pallavi Basu; Yi-Xin Liew; Jin-Yao Teo; Juinn-Huar Kam; Ser-Yee Lee; Peng-Chung Cheow; Premaraj Jeyaraj; Pierce K H Chow; Alexander Y F Chung; London L P J Ooi; Chung-Yip Chan; Brian K P Goh Journal: World J Surg Date: 2019-12 Impact factor: 3.352
Authors: Brian K P Goh; Ser-Yee Lee; Jin-Yao Teo; Juinn-Huar Kam; Prema-Raj Jeyaraj; Peng-Chung Cheow; Pierce K H Chow; London L P J Ooi; Alexander Y F Chung; Chung-Yip Chan Journal: Surg Endosc Date: 2018-07-02 Impact factor: 4.584
Authors: Hui Jun Lim; Adrian Kah Heng Chiow; Lip Seng Lee; Siong San Tan; Brian Kp Goh; Ye Xin Koh; Chung Yip Chan; Ser Yee Lee Journal: Singapore Med J Date: 2019-11-04 Impact factor: 1.858
Authors: Tousif Kabir; Zoe Z X Tan; Darren Weiquan Chua; Nicholas Syn; Brian K P Goh Journal: J Minim Access Surg Date: 2020 Jul-Sep Impact factor: 1.407
Authors: Ken Min Chin; Darren W Q Chua; Ser Yee Lee; Chung Yip Chan; Brian K P Goh Journal: J Minim Access Surg Date: 2021 Jan-Mar Impact factor: 1.407