BACKGROUND Laparoscopic liver resection (LLR) requires training in both hepatobiliary surgery and advanced laparoscopy. Available data on LLR learning curves are derived from pioneer surgeons. The aims of this study were to evaluate the LLR learning curve for second generation surgeons, and to compare different CUSUM methodology with and without risk adjustment. METHODS Retrospective analysis of a prospective database of 111 consecutive patients who underwent LLR by two surgeons at a single centre between 2011 and 2016. The LLR learning curve for minor hepatectomy (MH) was evaluated for each surgeon using standard CUSUM before and after risk-adjusting for operative difficulty using the Iwate index, and compared with Learning Curve (LC) CUSUM. The end points were operative time and conversion rate. RESULTS Standard CUSUM analysis identified a learning curve of 50-60 MH procedures. The corresponding learning curve reduced to 25-30 after risk-adjusting for operative difficulty, whilst LC-CUSUM identified a learning curve of 17-25 procedures. CONCLUSIONS The learning curve for laparoscopic minor liver resection by second generation surgeons is shorter than that for pioneer surgeons. Laparoscopic HPB fellowship programmes may further shorten the learning curve, facilitating safe expansion of LLR. The LC-CUSUM method is an alternative technique that warrants further study.

中文翻译：

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评估腹腔镜肝切除术的学习曲线：标准曲线和学习曲线CUSUM之间的比较研究。

背景技术腹腔镜肝切除术（LLR）需要肝胆外科手术和高级腹腔镜检查方面的培训。有关LLR学习曲线的可用数据来自先驱外科医生。这项研究的目的是评估第二代外科医生的LLR学习曲线，并比较有无风险调整的不同CUSUM方法。方法回顾性分析2011年至2016年间在同一中心由两名外科医生进行的111例连续患者接受LLR的前瞻性数据库。在风险调整前后，使用标准CUSUM对每位外科医生进行小肝切除术（MH）的LLR学习曲线进行了评估使用岩手索引评估手术难度，并与学习曲线（LC）CUSUM进行比较。终点是手术时间和转化率。结果标准CUSUM分析确定了50-60 MH程序的学习曲线。在对手术难度进行风险调整后，相应的学习曲线减少到25-30，而LC-CUSUM则确定了17-25程序的学习曲线。结论第二代外科医生对腹腔镜小肝切除术的学习曲线比先驱者短。腹腔镜HPB奖学金计划可进一步缩短学习曲线，促进LLR的安全扩展。LC-CUSUM方法是另一种值得进一步研究的技术。结论第二代外科医生对腹腔镜小肝切除术的学习曲线比先驱者短。腹腔镜HPB奖学金计划可进一步缩短学习曲线，促进LLR的安全扩展。LC-CUSUM方法是另一种值得进一步研究的技术。结论第二代外科医生进行腹腔镜小肝切除术的学习曲线比先驱者短。腹腔镜HPB奖学金计划可进一步缩短学习曲线，促进LLR的安全扩展。LC-CUSUM方法是另一种值得进一步研究的技术。