Brian K P Goh1,2, Mikel Prieto3, Nicholas Syn4, Ye-Xin Koh1, Kai-Inn Lim5. 1. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore. 2. Duke-National University of Singapore Medical School, Singapore. 3. Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, Bilbao, Spain. 4. Yong Loo Lin School of Medicine, National University of Singapore, Singapore. 5. Department of Anaesthesiology, Singapore General Hospital, Singapore.
Abstract
BACKGROUND: A recent study analysing the experience of fellowship-trained early adopting surgeons during stage 3 of the IDEAL paradigm demonstrated that the learning curve (LC) of minimally invasive hepatectomy (MIH) can be shortened compared to the long steep LC of pioneering surgeons. In this study, we aimed to critically appraise the contemporary learning experience with MIH of a 'self-taught' early adopter during stage 3 of the IDEAL paradigm. METHODS: A review of the first 200 patients who underwent MIH over an 88-month period since 2011 by a single surgeon who had no prior training in MIH was conducted. The cohort was divided into four groups of 50 patients. Risk-adjusted cumulative sum analysis of the LC was performed. RESULTS: Two hundred patients underwent MIH and there were 13 (6.5%) open conversions. There were 55 (27.5%) major resections and 94 (47.0%) were graded as high/expert difficulty according to the Iwate criteria. Fifty-one (25.5%) patients had cirrhosis and 98 (49%) had previous abdominal surgery including 28 (14%) with previous liver resections. There were five (2.5%) major (Grade 3b-5) morbidities, zero 30-day mortality and one (0.5%) 90-day mortality. Comparison across the four groups demonstrated a significant trend towards increased adoption of total MIH, increased multifocal tumours, increased performance of major hepatectomies and decreased blood loss. Risk-adjusted cumulative sum analysis demonstrated that the LC in terms of blood loss, blood transfusion rate, open conversion rate, operation time and post-operative length of stay to be 65 cases. The LC for MIH of Iwate low/intermediate difficulty and of Iwate high/expert difficulty were 35 and 30 cases, respectively. CONCLUSION: MIH of all difficulty levels is feasible and can be safely adopted today even by surgeons with no prior formal training. The LC of the 'self-taught' early adopter is about 65 cases.
BACKGROUND: A recent study analysing the experience of fellowship-trained early adopting surgeons during stage 3 of the IDEAL paradigm demonstrated that the learning curve (LC) of minimally invasive hepatectomy (MIH) can be shortened compared to the long steep LC of pioneering surgeons. In this study, we aimed to critically appraise the contemporary learning experience with MIH of a 'self-taught' early adopter during stage 3 of the IDEAL paradigm. METHODS: A review of the first 200 patients who underwent MIH over an 88-month period since 2011 by a single surgeon who had no prior training in MIH was conducted. The cohort was divided into four groups of 50 patients. Risk-adjusted cumulative sum analysis of the LC was performed. RESULTS: Two hundred patients underwent MIH and there were 13 (6.5%) open conversions. There were 55 (27.5%) major resections and 94 (47.0%) were graded as high/expert difficulty according to the Iwate criteria. Fifty-one (25.5%) patients had cirrhosis and 98 (49%) had previous abdominal surgery including 28 (14%) with previous liver resections. There were five (2.5%) major (Grade 3b-5) morbidities, zero 30-day mortality and one (0.5%) 90-day mortality. Comparison across the four groups demonstrated a significant trend towards increased adoption of total MIH, increased multifocal tumours, increased performance of major hepatectomies and decreased blood loss. Risk-adjusted cumulative sum analysis demonstrated that the LC in terms of blood loss, blood transfusion rate, open conversion rate, operation time and post-operative length of stay to be 65 cases. The LC for MIH of Iwate low/intermediate difficulty and of Iwate high/expert difficulty were 35 and 30 cases, respectively. CONCLUSION: MIH of all difficulty levels is feasible and can be safely adopted today even by surgeons with no prior formal training. The LC of the 'self-taught' early adopter is about 65 cases.
Authors: Tan-To Cheung; Xiaoying Wang; Mikhail Efanov; Rong Liu; David Fuks; Gi-Hong Choi; Nicholas L Syn; Charing C Chong; Iswanto Sucandy; Adrian K H Chiow; Marco V Marino; Mikel Gastaca; Jae Hoon Lee; T Peter Kingham; Mathieu D'Hondt; Sung Hoon Choi; Robert P Sutcliffe; Ho-Seong Han; Chung Ngai Tang; Johann Pratschke; Roberto I Troisi; Brian K P Goh Journal: Hepatobiliary Surg Nutr Date: 2021-10 Impact factor: 7.293
Authors: Ken Min Chin; Yun-Le Linn; Chin Kai Cheong; Ye-Xin Koh; Jin-Yao Teo; Alexander Y F Chung; Chung Yip Chan; Brian K P Goh Journal: J Gastrointest Surg Date: 2022-01-21 Impact factor: 3.452
Authors: Sneha Rajiv Jain; Wilson Sim; Cheng Han Ng; Yip Han Chin; Wen Hui Lim; Nicholas L Syn; Nur Haidah Bte Ahmad Kamal; Mehek Gupta; Valerie Heong; Xiao Wen Lee; Nur Sabrina Sapari; Xue Qing Koh; Zul Fazreen Adam Isa; Lucius Ho; Caitlin O'Hara; Arvindh Ulagapan; Shi Yu Gu; Kashyap Shroff; Rei Chern Weng; Joey S Y Lim; Diana Lim; Brendan Pang; Lai Kuan Ng; Andrea Wong; Ross Andrew Soo; Wei Peng Yong; Cheng Ean Chee; Soo-Chin Lee; Boon-Cher Goh; Richie Soong; David S P Tan Journal: Front Oncol Date: 2021-09-24 Impact factor: 6.244