Skip to main content

Advertisement

SpringerLink
Log in

Effective stepwise training and procedure standardization for young surgeons to perform laparoscopic left hepatectomy

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopic hepatectomy remains one of the most difficult procedures for young surgeons to perform. We recently developed a new training method and standardization procedure for teaching young surgeons to perform laparoscopic left hepatectomy (Lap-LHx). The aim of this study was to assess the effectiveness of our method.

Methods

In 2004, we standardized a laparoscopic procedure for Lap-LHx, using a laparoscopy-assisted method as a stepping stone. The laparoscopic training method comprised the following three steps: (1) training in fundamental procedures using a dry box and checking by mentors; (2) detailed preoperative simulation using Vincent three-dimensional software for each patient; and (3) self-assessment including understanding of relevant anatomy and completion grade for each procedure using a check sheet and feedback by both mentors and a professor. Twenty-three Lap-LHx procedures performed during the study period were divided into two groups: those performed by young non-board-certified surgeons (n = 9) and those performed by senior board-certified surgeons (n = 14).

Results

The blood loss and operative time were similar in the young surgeon (194 g and 336 min, respectively) and senior surgeon groups (208 g and 322 min, respectively).

Conclusion

Our standardized Lap-LHx procedure and stepwise training to perform it enable young surgeons to perform Lap-LHx as confidently and safely as more experienced surgeons.

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
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Gigot JF, de Goyet JDV, Van Beers BE, Reding R, Etienne J, Jadoul P, Michaux JL, Ferrant A, Cornu G, Otte JB, Pringot J, Kestens PJ (1996) Laparoscopic splenectomy in adults and children: experience with 31 patients. Surgery 119:384–389

    Article  CAS  PubMed  Google Scholar 

  2. Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Merety KS, Darcy MD, Long SR, Roemer FD, Pingleton ED, Thomson PG (1991) Laparoscopic nephrectomy. N Engl J Med 324:1370–1371

    CAS  PubMed  Google Scholar 

  3. Gagner M, Pomp A, Heniford BT, Pharand D, Lacroix A (1997) Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures. Ann Surg 226:238–246

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Croce E, Azzola M, Russo R, Golia M, Angelini S, Olmi S (1994) Laparoscopic liver tumour resection with the Argon Beam. Endosc Surg Allied Technol 2:186–188

    CAS  PubMed  Google Scholar 

  5. Rau HG, Meyer G, Cohnert TU, Schardey HM, Jauch K, Schildberg FW (1995) Laparoscopic liver resection with the water-jet dissector. Surg Endosc 9:1009–1012

    Article  CAS  PubMed  Google Scholar 

  6. Gugenheim J, Mazza D, Katkhouda N, Goubaux B, Mouiel J (1996) Laparoscopic resection of solid liver tumours. Br J Surg 83:334–335

    Article  CAS  PubMed  Google Scholar 

  7. Simillis C, Constantinides VA, Tekkis PP, Darzi A, Lovegrove R, Jiao L, Antoniou A (2007) Laparoscopic versus open hepatic resections for benign and malignant neoplasms: a meta-analysis. Surgery 141:203–211

    Article  PubMed  Google Scholar 

  8. Koffron AJ, Auffenberg G, Kung R, Abecassis M (2007) Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg 246:385–392

    Article  PubMed  PubMed Central  Google Scholar 

  9. Buell JF, Thomas MJ, Doty TC, Gersin KS, Merchen TD, Gupta M, Rudich SM, Woodle ES (2004) An initial experience and evolution of laparoscopic hepatic resectional surgery. Surgery 136:804–811

    Article  PubMed  Google Scholar 

  10. Descottes B, Glineur D, Lachachi F, Valleix D, Paineau J, Hamy A, Morino M, Bismuth H, Castaing D, Savier E, Honore P, Detry O, Legrand M, Azagra JS, Goergen M, Ceuterick M, Marescaux J, Mutter D, de Hemptinne B, Troisi R, Weerts J, Dallemagne B, Jehaes C, Gelin M, Donckier V, Aerts R, Topal B, Bertrand C, Mansvelt B, Van Krunckelsven L, Herman D, Kint M, Totte E, Schockmel R, Gigot JF (2003) Laparoscopic liver resection of benign liver tumors. Surg Endosc 17:23–30

    Article  CAS  PubMed  Google Scholar 

  11. Dulucq JL, Wintringer P, Stabilini C, Berticelli J, Mahajna A (2005) Laparoscopic liver resections: a single center experience. Surg Endosc 19:886–891

    Article  CAS  PubMed  Google Scholar 

  12. Farges O, Jagot P, Kirstetter P, Marty J, Belghiti J (2002) Prospective assessment of the safety and benefit of laparoscopic liver resections. J Hepatobiliary Pancreat Surg 9:242–248

    Article  PubMed  Google Scholar 

  13. Lesurtel M, Cherqui D, Laurent A, Tayar C, Fagniez PL (2003) Laparoscopic versus open left lateral hepatic lobectomy: a case–control study. J Am Coll Surg 196:236–242

    Article  PubMed  Google Scholar 

  14. Morino M, Morra I, Rosso E, Miglietta C, Garrone C (2003) Laparoscopic vs open hepatic resection a comparative study. Surg Endosc 17:1914–1918

    Article  CAS  PubMed  Google Scholar 

  15. 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

    PubMed  Google Scholar 

  16. Imura S, Shimada M, Utsunomiya T, Morine Y, Wakabayashi G, Kaneko H (2014) Current status of laparoscopic liver surgery in Japan: results of a multicenter Japanese experience. Surg Today 44:1214–1219

    Article  PubMed  Google Scholar 

  17. 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  PubMed  Google Scholar 

  18. Carswell KA, Sagias FG, Murgatroyd B, Rela M, Heaton N, Patel AG (2009) Laparoscopic versus open left lateral segmentectomy. BMC Surg 9:14

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hasegawa Y, Koffron AJ, Buell JF, Wakabayashi G (2015) Approaches to laparoscopic liver resection: a meta-analysis of the role of hand-assisted laparoscopic surgery and the hybrid technique. J Hepatobiliary Pancreat Sci 22:335–341

    Article  PubMed  Google Scholar 

  20. De Win G, Van Bruwaene S, Allen C, De Ridder D (2013) Design and implementation of a proficiency-based, structured endoscopy course for medical students applying for a surgical specialty. Adv Med Educ Pract 4:103–115

    Article  PubMed  PubMed Central  Google Scholar 

  21. McDougall EM, Kolla SB, Santos RT, Gan JM, Box GN, Louie MK, Gamboa AJ, Kaplan AG, Moskowitz RM, Andrade LA, Skarecky DW, Osann KE, Clayman RV (2009) Preliminary study of virtual reality and model simulation for learning laparoscopic suturing skills. J Urol 182:1018–1025

    Article  PubMed  Google Scholar 

  22. Botden SM, Torab F, Buzink SN, Jakimowicz JJ (2008) The importance of haptic feedback in laparoscopic suturing training and the additive value of virtual reality simulation. Surg Endosc 22:1214–1222

    Article  PubMed  Google Scholar 

  23. Verdaasdonk EG, Dankelman J, Lange JF, Stassen LP (2008) Transfer validity of laparoscopic knot-tying training on a VR simulator to a realistic environment: a randomized controlled trial. Surg Endosc 22:1636–1642

    Article  CAS  PubMed  Google Scholar 

  24. Cho A, Yamamoto H, Kainuma O, Ota T, Park S, Yanagibashi H, Arimitsu H, Ikeda A, Souda H, Nabeya Y, Takiguchi N, Nagata M (2012) Arantius’ ligament approach for the left extrahepatic Glissonean pedicle in pure laparoscopic left hemihepatectomy. Asian J Endosc Surg 5:187–190

    Article  PubMed  Google Scholar 

  25. Enkhbold Ch, Shimada M, Utsunomiya T, Ishibashi H, Yamada S, Kanamoto M, Arakawa Y, Ikemoto Z, Morine E, Imura S (2013) One-stop shop for 3-dimensional anatomy of hepatic vasculature and bile duct with special reference to biliary image reconstruction. Hepatogastroenterology 60:1861–1864

    PubMed  Google Scholar 

  26. Nunobe S, Hiki N, Tanimura S, Nohara K, Sano T, Yamaguchi T (2013) The clinical safety of performing laparoscopic gastrectomy for gastric cancer by trainees after sufficient experience in assisting. World J Surg 37:424–429

    Article  PubMed  Google Scholar 

  27. Jenkins JT, Currie A, Sala S, Kennedy RH (2016) A multi-modal approach to training in laparoscopic colorectal surgery accelerates proficiency gain. Surg Endosc. Surg Endosc 30:3007–3013

    Article  PubMed  Google Scholar 

  28. 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 

  29. Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, Hasegawa Y, Katagiri T, Takagi C, Itano O, Kaneko H, Wakabayashi G (2014) A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci 21:745–753

    Article  PubMed  Google Scholar 

  30. Van Sickle KR, Gallagher AG, Smith CD (2007) The effect of escalating feedback on the acquisition of psychomotor skills for laparoscopy. Surg Endosc 21:220–224

    Article  PubMed  Google Scholar 

  31. Strandbygaard J, Bjerrum F, Maagaard M, Winkel P, Larsen CR, Ringsted C, Gluud C, Grantcharov T, Ottesen B, Sorensen JL (2013) Instructor feedback versus no instructor feedback on performance in a laparoscopic virtual reality simulator: a randomized trial. Ann Surg 257:839–844

    Article  PubMed  Google Scholar 

  32. Harewood GC, Murray F, Winder S, Patchett S (2008) Evaluation of formal feedback on endoscopic competence among trainees: the EFFECT trial. Ir J Med Sci 177:253–256

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The content of this study was presented in the annual meeting of Society of American Gastrointestinal and Endoscopic Surgeons 2016, Boston, USA.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan

    Shinichiro Yamada, Mitsuo Shimada, Satoru Imura, Yuji Morine, Tetsuya Ikemoto, Yu Saito, Chie Takasu, Masato Yoshikawa, Hiroki Teraoku, Toshiaki Yoshimoto & Atsushi Takata

Authors
  1. Shinichiro Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mitsuo Shimada
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Satoru Imura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuji Morine
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tetsuya Ikemoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yu Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chie Takasu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masato Yoshikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hiroki Teraoku
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Toshiaki Yoshimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Atsushi Takata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shinichiro Yamada.

Ethics declarations

Disclosures

Shinichiro Yamada, Mitsuo Shimada, Satoru Imura, Yuji Morine, Tetsuya Ikemoto, Yu Saito, Chie Takasu, Masato Yoshikawa, Hiroki Teraoku, Toshiaki Yoshimoto, and Atsushi Takata have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yamada, S., Shimada, M., Imura, S. et al. Effective stepwise training and procedure standardization for young surgeons to perform laparoscopic left hepatectomy. Surg Endosc 31, 2623–2629 (2017). https://doi.org/10.1007/s00464-016-5273-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-016-5273-3

Keywords

Search

Navigation