Article Abstract

Laparoscopic liver resection in Malaysia—a single surgeon’s learning curve

Authors: Pei Yi Yap, Jan Jin Bong

Abstract

Background: Laparoscopic liver resections (LLR) has gradually replaced open surgery as the standard of care in many abdominal surgeries. Yet, there are few publications on the cases of LLR in South East Asian countries. In this study, a retrospective analysis was carried out to assess and report the outcomes of LLR from a single surgeon’s experience in Malaysia.
Methods: The clinical data of 44 patients who underwent LLR between October 2009 and December 2017 were retrospectively reviewed. Demographics, pathological diagnoses, types of resections performed, perioperative parameters, postoperative length of stay (LOS), postoperative complications and interventional procedures, and mortality data, were collected and analysed. Cumulative sum control chart (CUSUM) analysis was applied to the difficulty score to assess the single surgeon’s learning curve.
Results: Majority (77.3%) of the cases were of minor resections. A majority of the cases (79.5%) had tumours located at favourable segments (anterolateral segments). The open conversion rate was 13.6%. The median operative time was 138 min (45–344 min). The median estimated blood loss was 200 mL (50–2,000 mL) and the postoperative morbidity was 2.3%. The CUSUM analysis of the difficulty scoring identified two periods: period 1 (n=17 cases), with a mean difficulty scoring of 4.1; and period 2 (cases 18–44, n=27 cases), with a mean difficulty scoring of 5.1. period 2 presented a higher median operative time and a higher median estimated blood loss in comparison to period 1. No postoperative mortality was observed in this series.
Conclusions: Taking into account the various levels of operative techniques with different types of LLRs, more experience is needed to overcome the learning curve. Based on the single surgeon’s experience, the different types of LLRs are dependable and feasible on various hepatobiliary pathological diagnoses, with acceptable morbidity and mortality rates.