MILS in a general surgery unit: learning curve, indications, and limitations
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Minimally invasive liver surgery (MILS) is going to be a method with a wide diffusion even in general surgery units. Organization, learning curve effect, and the environment are crucial issues to evaluate before starting a program of minimally invasive liver resections. Analysis of a consecutive series of 70 patients has been used to define advantages and limits of starting a program of MILS in a general surgery unit. Seventeen MILS have been calculated with the cumulative sum method as the number of cases to complete the learning curve. Operative times [270 (60–480) vs. 180 (15–550) min; p 0.01] and rate of conversion (6/17 vs. 5/53; p 0.018) decrease after this number of cases. More complex cases can be managed after a proper optimization of all steps of liver resection. When a high confidence of the medical and nurse staff with MILS is reached, economical and strategic issues should be evaluated in order to establish a multidisciplinary hepatobiliary unit independent from the general surgery unit to manage more complex cases.
KeywordsLiver Laparoscopy Learning curve Robot-assisted surgery Hepatectomy General surgery
Compliance with ethical standards
Conflict of interest
I declare that in the study were respected the ethical standards conformed to the guidelines of the Helsinki Declaration (as revised in Tokyo 2004). No study advertising was made and no remuneration was offered.
Research involving human participants and/or animals
This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
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