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The learning curve in pure laparoscopic donor right hepatectomy: a cumulative sum analysis

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Abstract

Background

Although the use of pure laparoscopic donor hepatectomy (PLDH) is increasingly common, it remains limited to a few experienced centers and no data on the learning curve are currently available. The aim of this study is to evaluate the learning curve associated with the use of pure laparoscopic donor right hepatectomy (PLDRH).

Methods

Data from donors undergoing PLDRH performed by a single surgeon between November 2015 and October 2017 were retrospectively reviewed. The learning curve was evaluated using the cumulative sum (CUSUM) method based on duration of surgery.

Results

Of 100 donors evaluated, none required transfusion or conversion to open hepatectomy and no irreversible disability or mortality was reported. The mean operative time was 320.7 ± 51.8 min, and all grafts were successfully transplanted. The CUSUM analysis demonstrated a learning curve of approximately 60 cases of PLDRH. Estimated total liver volume > 1400 cm3 and double portal vein orifices were seen to be risk factors for longer surgery time. Having adjusted for case mix with these factors, the risk-adjusted CUSUM analysis demonstrated a learning curve of 65–70 cases of PLDRH.

Conclusions

In conclusion, PLDRH is a feasible and safe procedure with a learning curve of 65–70 cases.

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Abbreviations

ALT:

Alanine aminotransferase

APD:

anterior to posterior diameter

AST:

Aspartate aminotransferase

CUSUM:

Cumulative sum

Hb:

Hemoglobin

ICG:

Indocyanine green

PLDH:

Pure laparoscopic donor hepatectomy

PLDRH:

Pure laparoscopic donor right hepatectomy

TD:

Transverse diameter

References

  1. Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G (2016) Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg 263:761–777

    Article  Google Scholar 

  2. Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection-2,804 patients. Ann Surg 250:831–841

    Article  Google Scholar 

  3. Buell JF, Thomas MT, Rudich S, Marvin M, Nagubandi R, Ravindra KV, Brock G, McMasters KM (2008) Experience with more than 500 minimally invasive hepatic procedures. Ann Surg 248:475–486

    PubMed  Google Scholar 

  4. Topal B, Fieuws S, Aerts R, Vandeweyer H, Penninckx F (2008) Laparoscopic versus open liver resection of hepatic neoplasms: comparative analysis of short-term results. Surg Endosc 22:2208–2213

    Article  CAS  Google Scholar 

  5. Yoon YI, Kim KH, Kang SH, Kim WJ, Shin MH, Lee SK, Jung DH, Park GC, Ahn CS, Moon DB, Ha TY, Song GW, Hwang S, Lee SG (2017) Pure laparoscopic versus open right hepatectomy for hepatocellular carcinoma in patients with cirrhosis. Ann Surg 265:856–863

    Article  Google Scholar 

  6. Soubrane O, de Rougemont O, Kim KH, Samstein B, Mamode N, Boillot O, Troisi RI, Scatton O, Cauchy F, Lee SG, Griesemer A, Ahmed Z, Clavien PA, Cherqui D (2015) Laparoscopic living donor left lateral sectionectomy: a new standard practice for donor hepatectomy. Ann Surg 262:757–761

    Article  Google Scholar 

  7. Kim KH, Jung DH, Park KM, Lee YJ, Kim DY, Kim KM, Lee SG (2011) Comparison of open and laparoscopic live donor left lateral sectionectomy. Br J Surg 98:1302–1308

    Article  CAS  Google Scholar 

  8. Rotellar F, Pardo F, Benito A, Martí-Cruchaga P, Zozaya G, Lopez L, Hidalgo F, Sangro B, Herrero I (2013) Totally laparoscopic right-lobe hepatectomy for adult living donor liver transplantation: useful strategies to enhance safety. Am J Transplant 13:3269–3273

    Article  CAS  Google Scholar 

  9. Hong SK, Lee KW, Choi Y, Kim HS, Ahn SW, Yoon KC, Kim H, Yi NJ, Suh KS (2018) Initial experience with purely laparoscopic living-donor right hepatectomy. Br J Surg 105:751–759

    Article  CAS  Google Scholar 

  10. Suh KS, Hong SK, Lee KW, Yi NJ, Kim HS, Ahn SW, Yoon KC, Choi JY, Oh D, Kim H (2018) Pure laparoscopic living donor hepatectomy: focus on 55 donors undergoing right hepatectomy. Am J Transplant 18:434–443

    Article  CAS  Google Scholar 

  11. Cherqui D, Soubrane O, Husson E, Barshasz E, Vignaux O, Ghimouz M, Branchereau S, Chardot C, Gauthier F, Fagniez PL, Houssin D (2002) Laparoscopic living donor hepatectomy for liver transplantation in children. Lancet 359:392–396

    Article  Google Scholar 

  12. Soubrane O, Perdigao Cotta F, Scatton O (2013) Pure laparoscopic right hepatectomy in a living donor. Am J Transplant 13:2467–2471

    Article  CAS  Google Scholar 

  13. Samstein B, Griesemer A, Cherqui D, Mansour T, Pisa J, Yegiants A, Fox AN, Guarrera JV, Kato T, Halazun KJ, Emond J (2015) Fully laparoscopic left-sided donor hepatectomy is safe and associated with shorter hospital stay and earlier return to work: a comparative study. Liver Transpl 21:768–773

    Article  Google Scholar 

  14. Kim KH, Kang SH, Jung DH, Yoon YI, Kim WJ, Shin MH, Lee SG (2017) Initial outcomes of pure laparoscopic living donor right hepatectomy in an experienced adult living donor liver transplant center. Transplantation 101:1106–1110

    Article  Google Scholar 

  15. Takahara T, Wakabayashi G, Hasegawa Y, Nitta H (2015) Minimally invasive donor hepatectomy: evolution from hybrid to pure laparoscopic techniques. Ann Surg 261:e3–e4

    Article  Google Scholar 

  16. Scatton O, Katsanos G, Boillot O, Goumard C, Bernard D, Stenard F, Perdigao F, Soubrane O (2015) Pure laparoscopic left lateral sectionectomy in living donors: from innovation to development in France. Ann Surg 261:506–512

    Article  Google Scholar 

  17. Samstein B, Cherqui D, Rotellar F, Griesemer A, Halazun KJ, Kato T, Guarrera J, Emond JC (2013) Totally laparoscopic full left hepatectomy for living donor liver transplantation in adolescents and adults. Am J Transplant 13:2462–2466

    Article  CAS  Google Scholar 

  18. Rotellar F, Pardo F, Benito A, Zozaya G, Martí-Cruchaga P, Hidalgo F, Lopez L, Iñarrairaegui M, Sangro B, Herrero I (2017) Totally laparoscopic right hepatectomy for living donor liver transplantation: analysis of a preliminary experience on 5 consecutive cases. Transplantation 101:548–554

    Article  Google Scholar 

  19. Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS; World Consensus Conference on Laparoscopic Surgery (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830

    Article  Google Scholar 

  20. Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, OʼRourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schön MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261:619–629

    Google Scholar 

  21. Nugroho A, Kim OK, Lee KW, Song S, Kim H, Hong SK, Yoon KC, Kim HS, Choi Y, Lee HW, Yi NJ, Suh KS (2017) Evaluation of donor workups and exclusions in a single-center experience of living donor liver transplantation. Liver Transpl 23:614–624

    Article  Google Scholar 

  22. Hong SK, Lee KW, Kim HS, Yoon KC, Ahn SW, Choi JY, Kim H, Yi NJ, Suh KS (2017) Optimal bile duct division using real-time indocyanine green near-infrared fluorescence cholangiography during laparoscopic donor hepatectomy. Liver Transpl 23:847–852

    Article  Google Scholar 

  23. Suh KS, Hong SK, Yi NJ, Lee KW, Kim HS, Yoon KC, Kim H (2016) Pure 3-dimensional laparoscopic extended right hepatectomy in a living donor. Liver Transpl 22:1431–1436

    Article  Google Scholar 

  24. Hong SK, Suh KS, Kim HS, Yoon KC, Ahn SW, Oh D, Kim H, Yi NJ, Lee KW (2017) Pure 3D laparoscopic living donor right hemihepatectomy in a donor with separate right posterior and right anterior hepatic ducts and portal veins. Surg Endosc 31:4834–4835

    Article  Google Scholar 

  25. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  Google Scholar 

  26. Safwan M, Nagai S, Collins K, Rizzari M, Yoshida A, Abouljoud M (2018) Impact of abdominal shape on living liver donor outcomes in mini-incision right hepatic lobectomy: comparison among 3 techniques. Liver Transpl 24:516–527

    Article  Google Scholar 

  27. Wang W, Ai KX, Tao F, Jin KT, Jing YM, Xu GG, Lv JQ, Wang T, Wei JG, Sun AJ, Xing HY (2016) Impact of abdominal shape on short-term surgical outcome of laparoscopy-assisted distal gastrectomy for gastric cancer. J Gastrointest Surg 20:1091–1097

    Article  Google Scholar 

  28. Lee JH, Paik YH, Lee JS, Ryu KW, Kim CG, Park SR, Kim YW, Kook MC, Nam BH, Bae JM (2007) Abdominal shape of gastric cancer patients influences short-term surgical outcomes. Ann Surg Oncol 14:1288–1294

    Article  Google Scholar 

  29. Williams SM, Parry BR, Schlup MM (1992) Quality control: an application of the cusum. BMJ 304:1359–1361

    Article  CAS  Google Scholar 

  30. Yap CH, Colson ME, Watters DA (2007) Cumulative sum techniques for surgeons: a brief review. ANZ J Surg 77:583–586

    Article  Google Scholar 

  31. Takahara T, Wakabayashi G, Nitta H, Hasegawa Y, Katagiri H, Umemura A, Takeda D, Makabe K, Otsuka K, Koeda K, Sasaki A (2017) The first comparative study of the perioperative outcomes between pure laparoscopic donor hepatectomy and laparoscopy-assisted donor hepatectomy in a single institution. Transplantation 101:1628–1636

    Article  Google Scholar 

  32. Lee KW, Hong SK, Suh KS, Kim HS, Ahn SW, Yoon KC, Lee JM, Cho JH, Kim H, Yi NJ (2018) One hundred fifteen cases of pure laparoscopic living donor right hepatectomy at a single center. Transplantation 102:1878–1884

    Article  Google Scholar 

  33. Vigano L, Laurent A, Tayar C, Tomatis M, Ponti A, Cherqui D (2009) The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg 250:772–782

    Article  Google Scholar 

  34. van der Poel MJ, Besselink MG, Cipriani F, Armstrong T, Takhar AS, van Dieren S, Primrose JN, Pearce NW, Abu Hilal M (2016) Outcome and learning curve in 159 consecutive patients undergoing total laparoscopic hemihepatectomy. JAMA Surg 151:923–928

    Article  Google Scholar 

  35. Chiow AK, Lee SY, Chan CY, Tan SS (2015) Learning curve in laparoscopic liver surgery: a fellow’s perspective. Hepatobilliary Surg Nutr 4:411–416

    Google Scholar 

  36. Nomi T, Fuks D, Kawaguchi Y, Mal F, Nakajima Y, Gayet B (2015) Learning curve for laparoscopic major hepatectomy. Br J Surg 102:796–804

    Article  CAS  Google Scholar 

  37. Lee W, Woo JW, Lee JK, Park JH, Kim JY, Kwag SJ, Park T, Jeong SH, Ju YT, Jeong EJ, Lee YJ, Choi SK, Hong SC, Jeong CY (2016) Comparison of learning curves for major and minor laparoscopic liver resection. J Laparoendosc Adv Surg Tech A 26:457–464

    Article  Google Scholar 

  38. Hong SK, Suh KS, Kim HS, Yoon KC, Ahn SW, Kim H, Yi NJ, Lee KW (2018) Pediatric living donor liver transplantation using a monosegment procured by pure 3D laparoscopic left lateral sectionectomy and in situ reduction. J Gastrointest Surg 22:1135–1136

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongrogu, Seoul, 03080, Republic of Korea

    Suk Kyun Hong, Kyung-Suk Suh, Jeong-Moo Lee, Jae-Hyung Cho, Nam-Joon Yi & Kwang-Woong Lee

  2. Department of Surgery, Division of HBP Surgery & Liver Transplantation, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea

    Kyung Chul Yoon

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  1. Suk Kyun Hong
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Correspondence to Kyung-Suk Suh.

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Suk Kyun Hong, Kyung-Suk Suh, Kyung Chul Yoon, Jeong-Moo Lee, Jae-Hyung Cho, Nam-Joon Yi, and Kwang-Woong Lee have no conflicts of interest or financial ties to disclose.

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Hong, S.K., Suh, KS., Yoon, K.C. et al. The learning curve in pure laparoscopic donor right hepatectomy: a cumulative sum analysis. Surg Endosc 33, 3741–3748 (2019). https://doi.org/10.1007/s00464-019-06668-3

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