Skip to main content

Advertisement

SpringerLink
Log in

Learning Curve in Laparoscopic Liver Resection, Educational Value of Simulation and Training Programmes: A Systematic Review

  • Scientific Review
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The laparoscopic approach is widely accepted as the procedure of choice for abdominal surgery. However, laparoscopic liver resection (LLR) has advanced slowly due to the significant learning curve (LC), and only few publications have dealt with advanced training in LLR.

Methods

Two reviewers conducted systematic research through MEDLINE and EMBASE with combinations of the following keywords: (learning curve OR teaching OR training OR simulation OR education) AND (liver OR hepatic) AND (laparoscopic OR laparoscopy). Robotic-assisted, hand-assisted and hybrid LLRs were excluded.

Results

Nineteen studies were retrieved. Overall, the level of evidence was low. Thirteen articles assessed the LC during real-life LLR, and six articles focussed on simulation and training programmes in LLR. The LC in minor LLR comprised 60 cases overall, and 15 cases for standardised left lateral sectionectomy. For major LLR (MLLR), the LC was 50 cases for most studies, but was reported to be 15–20 cases in more recent studies, provided MLLR is performed progressively in selected patients. However, there was heterogeneity in the literature regarding the number of minor LLRs required before MLLR, with 60 minor LLRs reported as the minimum. Six studies showed a potential benefit of simulation and training programmes in this field. The gradual implementation of LLR combined with simulation-based training programmes could reduce the clinical impact of LC.

Conclusions

The LC in LLR is a long process, and MLLR should be gradually implemented under the supervision of experienced surgeons. Training outside the operating room may reduce the LC in real-life situations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Fleshman J, Sargent DJ, Green E et al (2007) Clinical Outcomes of Surgical Therapy Study Group. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246:655–662

    Article  Google Scholar 

  2. Bonjer HJ, Deijen CL, Abis GA; Color II Study Group (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372:1324–1332

    Article  Google Scholar 

  3. Tranchart H, Dagher I (2014) Laparoscopic liver resection: a review. J Visc Surg 151:114–122

    Google Scholar 

  4. Wakabayashi G, Cherqui D, Geller DA et al (2015) Recommendations for laparoscopic liver resection a report from the second international consensus conference held in Morioka. Ann Surg 261:619–629

    PubMed  Google Scholar 

  5. Kasai M, Cipriani F, Gayet B et al (2018) Laparoscopic versus open major hepatectomy: a systematic review and meta-analysis of individual patient data. Surgery 163:985–995

    Article  Google Scholar 

  6. Tranchart H, Di Giuro G, Lainas P et al (2010) Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 24:1170–1176

    Article  Google Scholar 

  7. Dagher I, Di Giuro G, Dubrez J et al (2009) Laparoscopic versus open right hepatectomy: a comparative study. Am J Surg 198:173–177

    Article  Google Scholar 

  8. Belli G, Cioffi L, Fantini C et al (2009) Laparoscopic redo surgery for recurrent hepatocellular carcinoma in cirrhotic patients: feasibility, safety, and results. Surg Endosc 23:1807–1811

    Article  Google Scholar 

  9. Buell JF, Cherqui D, Geller DA, World Consensus Conference on Laparoscopic Surgery et al (2009) The international position on laparoscopic liver surgery: the Louisville statement 2008. Ann Surg 250:825–830

    Article  Google Scholar 

  10. Ban D, Tanabe M, Ito H et al (2014) A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci 21:745–753

    Article  Google Scholar 

  11. Halls MC, Cherqui D, Taylor MA, Collaborators of The Difficulty of Laparoscopic Liver Surgery Survey et al (2018) Are the current difficulty scores for laparoscopic liver surgery telling the whole story? An international survey and recommendations for the future. HPB 20:231–236

    Article  Google Scholar 

  12. Hasegawa Y, Wakabayashi G, Nitta H et al (2017) A novel model for prediction of pure laparoscopic liver resection surgical difficulty. Surg Endosc 31:5356–5363

    Article  Google Scholar 

  13. Tanaka S, Kubo S, Kanazawa A et al (2017) Validation of a difficulty scoring system for laparoscopic liver resection: a multicenter analysis by the endoscopic liver surgery study group in Japan. J Am Coll Surg 225:249–258

    Article  Google Scholar 

  14. Kawaguchi Y, Fuks D, Kokudo N et al (2018) Difficulty of laparoscopic liver resection: proposal for a new classification. Ann Surg 267:13–17

    Article  Google Scholar 

  15. Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269

    Article  Google Scholar 

  16. Couinaud C (1957) Le foie: etudes anatomiques et chirurgicales. Masson et Cie, Paris

    Google Scholar 

  17. Vigano L, Laurent A, Tayar C et al (2009) The learning curve in laparoscopic liver resection. Improved feasibility and reproducibility. Ann Surg 250:772–782

    Article  Google Scholar 

  18. Nomi T, Fuks D, Kawaguchi Y et al (2015) Learning curve for laparoscopic major hepatectomy. Br J Surg 102:796–804

    Article  CAS  Google Scholar 

  19. Lee W, Woo JW, Lee JK et al (2016) Comparison of learning curves for major and minor laparoscopic liver resection. J Laparoendosc Adv Surg Tech A 26:457–464

    Article  Google Scholar 

  20. van der Poel MJ, Besselink MG, Cipriani F et al (2016) Outcome and learning curve in 159 consecutive patients undergoing total laparoscopic hemihepatectomy. JAMA Surg 151:923–928

    Article  Google Scholar 

  21. Komatsu S, Scatton O, Goumard C et al (2016) Development process and technical aspects of laparoscopic hepatectomy: learning curve based on 15 years of experience. J Am Coll Surg 224:841–850

    Article  Google Scholar 

  22. Liu W, Wang Q, Huang J et al (2014) Laparoscopic left lateral sectionectomy—the learning curve and the role of left hepatic inflow occlusion. Hepatogastroenterology 61:417–421

    PubMed  Google Scholar 

  23. Cai X, Li Z, Zhang Y et al (2014) Laparoscopic liver resection and the learning curve: a 14-year, single-center experience. Surg Endosc 28:1334–1341

    Article  Google Scholar 

  24. Lin CW, Tsai TJ, Cheng TY et al (2016) The learning curve of laparoscopic liver resection after the Louisville statement 2008: will it be more effective and smooth? Surg Endosc 30:2895–2903

    Article  Google Scholar 

  25. Hasegawa Y, Nitta H, Takahara T et al (2017) Safely extending the indications of laparoscopic liver resection: when should we start laparoscopic major hepatectomy? Surg Endosc 31:309–316

    Article  Google Scholar 

  26. van Rij AM, McDonald JR, Pettigrew RA et al (1995) Cusum as an aid to early assessment of the surgical trainee. Br J Surg 82:1500–1503

    Article  Google Scholar 

  27. Higgins JPT, Green, S (2016) Cochrane handbook for systematic reviews of intervention 5.1.0 (updated March 2011). The Cochrane Library. Issue 4. Chichester, Wiley

  28. Gluud C, Als-Nielsen B, D'Amico G, et al (2007) Cochrane hepato-biliary group. about the cochrane collaboration (Cochrane Reviews Groups (CRGs)). Issue 2. Art. no.: LIVER. Wiley, Chichester

  29. Ratti F, Barkhatov LI, Tomassini F et al (2016) Learning curve of self-taught laparoscopic liver surgeons in left lateral sectionectomy: results from an international multi-institutional analysis on 245 cases. Surg Endosc 30:3618–3629

    Article  Google Scholar 

  30. Villani V, Bohnen JD, Torabi R et al (2016) “Idealized” vs. “true” learning curves: the case of laparoscopic liver resection. HPB 18:504–509

    Article  Google Scholar 

  31. Abu Hilal M, Pearce NW (2008) Laparoscopic left lateral liver sectionectomy: a safe, efficient, reproducible technique. Dig Surg 25:305–308

    Article  CAS  Google Scholar 

  32. O'Connor VV, Vuong B, Yang ST et al (2017) Robotic minor hepatectomy offers a favorable learning curve and may result in superior perioperative outcomes compared with laparoscopic approach. Am Surg 83:1085–1088

    PubMed  Google Scholar 

  33. Tomassini F, Scuderi V, Colman R et al (2016) The single surgeon learning curve of laparoscopic liver resection. Medicine (Baltimore) 95:e5138

    Article  Google Scholar 

  34. Strickland A, Fairhurst K, Lauder C et al (2011) Development of an ex vivo simulated training model for laparoscopic liver resection. Surg Endosc 25:1677–1682

    Article  Google Scholar 

  35. Xiao J, Cui Z, Fu M et al (2016) An ex vivo liver training model continuously perfused to simulate bleeding for suture skills involved in laparoscopic liver resection: development and validity. Surg Endosc 30:4553–4561

    Article  Google Scholar 

  36. Udomsawaengsup S, Pattana-arun J, Tansatit T et al (2005) Minimally invasive surgery training in soft cadaver (MIST-SC). J Med Assoc Thai 88:S189–194

    PubMed  Google Scholar 

  37. Teh SH, Hunter JG, Sheppard BC (2007) A suitable animal model for laparoscopic hepatic resection training. Surg Endosc 21:1738–1744

    Article  Google Scholar 

  38. Komorowski AL, Mituś JW, Sanchez Hurtado MA et al (2015) Porcine model in the laparoscopic liver surgery training. Pol Przegl Chir 87:425–428

    PubMed  Google Scholar 

  39. White SA, Satchidanand RY, French JJ et al (2014) A cadaver lab training facility to facilitate laparoscopic liver resection. Surg Laparosc Endosc Percutan Tech 24:357–360

    Article  Google Scholar 

  40. Goutte N, Bendersky N, Barbier L et al (2017) Laparoscopic left lateral sectionectomy: a population-based study. HPB 19:118–125

    Article  Google Scholar 

  41. Ciria R, Cherqui D, Geller DA et al (2016) Comparative short-term benefits of laparoscopic liver resection: 9,000 cases and climbing. Ann Surg 263:761–777

    Article  Google Scholar 

  42. Abu Hilal M, Aldrighetti L, Dagher I et al (2018) The southampton consensus guidelines for laparoscopic liver surgery. Ann Surg 268:11–18

    Article  Google Scholar 

  43. Brown KM, Geller DA (2016) What is the learning curve for laparoscopic major hepatectomy? J Gastrointest Surg 20:1065–1071

    Article  Google Scholar 

  44. Hasegawa Y, Nitta H, Sasaki A et al (2013) Laparoscopic left lateral sectionectomy as a training procedure for surgeons learning laparoscopic hepatectomy. J Hepatobiliary Pancreat Sci 20:525–530

    Article  Google Scholar 

  45. Soubrane O, Schwarz L, Cauchy F et al (2015) A conceptual technique for laparoscopic right hepatectomy based on facts and oncologic principles: the caudal approach. Ann Surg 261:1226–1231

    Article  Google Scholar 

  46. Halls MC, Alseidi A, Berardi G et al (2018) A comparison of the learning curves of laparoscopic liver surgeons in differing stages of the IDEAL paradigm of surgical innovation: standing on the shoulders of pioneers. Ann Surg 269:221–228

    Article  Google Scholar 

  47. Sutherland LM, Middleton PF, Anthony A et al (2006) Surgical simulation: a systematic review. Ann Surg 243:291–300

    Article  Google Scholar 

  48. Grantcharov TP, Kristiansen VB, Bendix J et al (2004) Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg 91:146–150

    Article  CAS  Google Scholar 

  49. Seymour NE, Gallagher AG, Roman SA et al (2002) Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 236:458–463

    Article  Google Scholar 

  50. Scott DJ, Bergen PC, Rege RV et al (2000) Laparoscopic training on bench models: better and more cost effective than operating room experience? J Am Coll Surg 191:272–283

    Article  CAS  Google Scholar 

  51. Beyer L, De Troyer J, Mancini J et al (2011) Impact of laparoscopy simulator training on the technical skills of future surgeons in the operating room: a prospective study. Am J Surg 202:265–272

    Article  Google Scholar 

  52. De Win G, Van Bruwaene S, Kulkarni J et al (2016) An evidence-based laparoscopic simulation curriculum shortens the clinical learning curve and reduces surgical adverse events. Adv Med Educ Pract 30:357–370

    Article  Google Scholar 

  53. Bansal VK, Raveendran R, Misra MC et al (2014) A prospective randomized controlled blinded study to evaluate the effect of short-term focused training program in laparoscopy on operating room performance of surgery residents (CTRI /2012/11/003113). J Surg Educ 71:52–60

    Article  Google Scholar 

  54. Beyer-Berjot L, Palter V, Grantcharov T et al (2014) Advanced training in laparoscopic abdominal surgery: a systematic review. Surgery 156:676–688

    Article  Google Scholar 

  55. Helling TS, Khandelwal A (2008) The challenges of resident training in complex hepatic, pancreatic, and biliary procedures. J Gastrointest Surg 12:153–158

    Article  Google Scholar 

  56. Beyer-Berjot L, Pucher P, Patel V et al (2017) Colorectal surgery and enhanced recovery: impact of a simulation-based care pathway training curriculum. J Visc Surg 154:313–320

    Article  CAS  Google Scholar 

  57. Lin E, Szomstein S, Addasi T et al (2003) Model for teaching laparoscopic colectomy to surgical residents. Am J Surg 186:45–48

    Article  Google Scholar 

  58. van der Poel MJ, Huisman F, Busch OR et al (2017) Stepwise introduction of laparoscopic liver surgery: validation of guideline recommendations. HPB 19:894–900

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France

    Théophile Guilbaud, David Jérémie Birnbaum, Stéphane Berdah & Laura Beyer Berjot

  2. Department of Pancreatic and Hepatobiliary Surgery, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université Paris VII, 100 Boulevard du Général Leclerc, 92110, Clichy, France

    Olivier Farges

Authors
  1. Théophile Guilbaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Jérémie Birnbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stéphane Berdah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olivier Farges
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Laura Beyer Berjot
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Théophile Guilbaud.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guilbaud, T., Birnbaum, D.J., Berdah, S. et al. Learning Curve in Laparoscopic Liver Resection, Educational Value of Simulation and Training Programmes: A Systematic Review. World J Surg 43, 2710–2719 (2019). https://doi.org/10.1007/s00268-019-05111-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-019-05111-x

Search

Navigation