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HPB (Oxford). 2017 Oct;19(10):894-900. doi: 10.1016/j.hpb.2017.06.007. Epub 2017 Jul 8.

Stepwise introduction of laparoscopic liver surgery: validation of guideline recommendations.

Author information

1
Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.j.vanderpoel@amc.nl.
2
Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
3
Hepatobiliary and Pancreatic Surgery Unit, Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
4
Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.g.besselink@amc.nl.

Abstract

BACKGROUND:

Uncontrolled introduction of laparoscopic liver surgery (LLS) could compromise postoperative outcomes. A stepwise introduction of LLS combined with structured training is advised. This study aimed to evaluate the impact of such a stepwise introduction.

METHODS:

A retrospective, single-center case series assessing short term outcomes of all consecutive LLS in the period November 2006-January 2017. The technique was implemented in a stepwise fashion. To evaluate the impact of this stepwise approach combined with structured training, outcomes of LLS before and after a laparoscopic HPB fellowship were compared.

RESULTS:

A total of 135 laparoscopic resections were performed. Overall conversion rate was 4% (n = 5), clinically relevant complication rate 13% (n = 18) and mortality 0.7% (n = 1). A significant increase in patients with major LLS, multiple liver resections, previous abdominal surgery, malignancies and lesions located in posterior segments was observed after the fellowship as well as a decrease in the use of hand-assistance. Increasing complexity in the post fellowship period was reflected by an increase in operating times, but without comprising other surgical outcomes.

CONCLUSION:

A stepwise introduction of LLS combined with structured training reduced the clinical impact of the learning curve, thereby confirming guideline recommendations.

PMID:
28698017
DOI:
10.1016/j.hpb.2017.06.007
[Indexed for MEDLINE]

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