Observational studyMedicine2016
The single surgeon learning curve of laparoscopic liver resection: A continuous evolving process through stepwise difficulties.
Observational study in Medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
28 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Learning Curve in Laparoscopic Liver Resection, Educational Value of Simulation and Training Programmes: A Systematic Review.World journal of surgery · 2019Pooled it
- Pooled it
- Reaching proficiency in robotic liver surgery in two high-volume European HPB centers.Journal of robotic surgery · 2026Article
- Technical proficiency assessment of robotic intracorporeal single-stapling colorectal anastomosis using video-based RA-CUSUM.International journal of colorectal disease · 2026Article
- Multicenter Belgian prospective registry on minimally invasive and open liver surgery (BReLLS): experience from 1342 consecutive cases.Langenbeck's archives of surgery · 2025Article
- Technical aspects and learning curve of complex laparoscopic hepatectomy: how we do it.Surgical endoscopy · 2024Article
- Towards a Standardization of Learning Curve Assessment in Minimally Invasive Liver Surgery.Annals of surgery · 2024Article
- Da Vinci robot-assisted retroperitoneal tumor resection in 105 patients: a single-center experience.Frontiers in oncology · 2024Article
- Propensity score-matched analysis of laparoscopic-assisted and hand-assisted laparoscopic liver resection versus pure laparoscopic liver resection: an international multicenter study.Surgical endoscopy · 2023Article
- Four-year experience with more than 1000 cases of total laparoscopic liver resection in a single center.World journal of gastroenterology · 2022Article
- Article
- Effect of the learning curve on survival after laparoscopic liver resection for colorectal metastases.BJS open · 2022Article
- Laparoscopic isolated caudate lobe resection.Scientific reports · 2021Article
- Laparoscopic liver resection: indications, limitations, and economic aspects.Langenbeck's archives of surgery · 2020Review
- Laparoscopic pancreaticoduodenectomy for periampullary tumors: lessons learned from 500 consecutive patients in a single center.Surgical endoscopy · 2020Article
- Laparoscopic Liver Surgery Training Course on Thiel-Embalmed Human Cadavers: Program Evaluation, Trainer's Long-Term Feedback and Steps Forward.World journal of surgery · 2019Article
- A stepwise learning curve to define the standard for technical improvement in laparoscopic liver resections: complexity-based analysis in 1032 procedures.Updates in surgery · 2019Article
- Ultrasound liver map technique for laparoscopic liver resections: perioperative outcomes are not impaired by technical complexity.Updates in surgery · 2019Article
- Laparoscopic liver resection-education and training.Translational gastroenterology and hepatology · 2019Article
- [Technical aspects of laparoscopic liver surgery : Transfer from open to laparoscopic liver surgery].Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen · 2018Review
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The aim of the study was to evaluate the single-surgeon learning curve (SSLC) in laparoscopic liver surgery over an 11-year period with risk-adjusted (RA) cumulative sum control chart analysis.Laparoscopic liver resection (LLR) is a challenging and highly demanding procedure. No specific data are available for defining the feasibility and reproducibility of the SSLC regarding a consistent and consecutive caseload volume over a specified time period.A total of 319 LLR performed by a single surgeon between June 2003 and May 2014 were retrospectively analyzed. A difficulty scale (DS) ranging from 1 to 10 was created to rate the technical difficulty of each LLR. The risk-adjusted cumulative sum control chart (RA-CUSUM) analysis evaluated conversion rate (CR), operative time (OT) and blood loss (BL). Perioperative morbidity and mortality were also analyzed.The RA-CUSUM analysis of the DS identified 3 different periods: P1 (n = 91 cases), with a mean DS of 3.8; P2 (cases 92-159), with a mean DS of 5.3; and P3 (cases 160-319), with a mean DS of 4.7. P2 presented the highest conversion and morbidity rates with a longer OT, whereas P3 showed the best results (P < 0.001). Fifty cases were needed to achieve a significant decrease in BL. The overall morbidity rate was 13.8%; no perioperative mortality was observed.According to our analysis, at least 160 cases (P3) are needed to complete the SSLC performing safely different types of LLR. A minimum of 50 cases can provide a significant decrease in BL. Based on these findings, a longer learning curve should be anticipated to broaden the indications for LLR.
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