Background

To improve patient safety, we standardized our surgical technique and implemented a stepwise strategy for surgeons learning to perform laparoscopic liver resection (LLR). The aim of the study is to describe how the stepwise training approach and standardized LLR affects surgical outcomes.

Methods

Data from 272 consecutive patients who underwent LLR from January 2009 to December 2017 were retrospectively reviewed. The risk-adjusted cumulative sum (RA-CUSUM) of surgical failures (conversion to laparotomy, blood transfusion, or Clavien-Dindo grade ≥3) and the CUSUM of operative time were used to determine optimal number of operations needed to achieve the best surgical outcome.

Results

As the surgeon moved from simple to complex procedures, the complication rates, need for transfusions, and conversion rates did not increase over time. After 53 cases of minor LLR, a learning curve of 21 cases was achieved for right hepatectomy. Blood loss and operative time significantly improved thereafter. For minor anterolateral and posterosuperior segment resections, blood loss, and operative time significantly improved at the 37th and 31st case, respectively, given that the anterolateral segments had more complex surgeries performed.

Conclusion

Standardization of the operative technique and the implementation of a stepwise approach to training surgeons to perform LLRs could considerably improve surgical outcomes.

中文翻译：

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橡胶牵引技术逐步发展腹腔镜肝切除术。

背景

为了提高患者的安全性，我们标准化了我们的手术技术，并为外科医生学习执行腹腔镜肝切除术 (LLR) 实施了逐步策略。该研究的目的是描述逐步训练方法和标准化 LLR 如何影响手术结果。

方法

回顾性分析了 2009 年 1 月至 2017 年 12 月连续接受 LLR 的 272 例患者的数据。手术失败（转换为剖腹手术、输血或 Clavien-Dindo ≥3 级）的风险调整累积和 (RA-CUSUM) 和手术时间的 CUSUM 用于确定实现最佳手术所需的最佳手术次数结果。

结果

随着外科医生从简单手术转向复杂手术，并发症发生率、输血需求和转化率并未随着时间的推移而增加。53 例轻微 LLR 后，右肝切除术达到 21 例学习曲线。此后失血量和手术时间显着改善。对于较小的前外侧和后上段切除术，第 37 例和第 31 例的失血量和手术时间分别显着改善，因为前外侧段进行了更复杂的手术。

结论

手术技术的标准化和逐步培训外科医生执行 LLR 的方法可以显着改善手术结果。