ArticleUpdates in surgery2019
A stepwise learning curve to define the standard for technical improvement in laparoscopic liver resections: complexity-based analysis in 1032 procedures.
Article in Updates in surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Systematic review of perioperative and oncologic outcomes of minimally-invasive surgery for hilar cholangiocarcinoma.Updates in surgery · 2021Pooled it
- Assessment of the learning curve of robotic liver resection using complexity-adjusted CUSUM analysis.Journal of robotic surgery · 2026Article
- From Synthesis to Mechanism: Biological Evaluation of a p-Toluidine-Based Thiazolidinone-Quinoline VEGFR-2 Candidate Supported by CADD.International journal of molecular sciences · 2026Article
- Validation of the Institute Mutualiste Montsouris system for the stratification of laparoscopic liver resections: an international multicenter study.Hepatobiliary surgery and nutrition · 2026Article
- Predictive risk factors for resection surface-related complications after laparoscopic simultaneous resection of primary colorectal tumor and synchronous liver metastases: a single-center retrospective study.Surgical endoscopy · 2024Article
- Towards a Standardization of Learning Curve Assessment in Minimally Invasive Liver Surgery.Annals of surgery · 2024Article
- A "cui prodest" evaluation on the development of a minimally invasive liver surgery program: a differential benefit analysis of open and laparoscopic approach for left and right hemihepatectomies.Surgical endoscopy · 2023Article
- Laparoscopic versus Robotic Hepatectomy: A Systematic Review and Meta-Analysis.Journal of clinical medicine · 2022Review
- Have we really understood when the efforts of laparoscopic liver resection are justified?-a complexity-based appraisal of the differential benefit.Hepatobiliary surgery and nutrition · 2022Article
- Development of a novel educational tool to assess skills in laparoscopic liver surgery using the Delphi methodology: the laparoscopic liver skills scale (LLSS).Surgical endoscopy · 2022Article
- ASO Author Reflections: The SMART-ALPPS Protocol-Strategy to Minimize ALPPS Risks by Targeting Invasiveness.Annals of surgical oncology · 2021Article
- Evolution of Surgical Treatment of Colorectal Liver Metastases in the Real World: Single Center Experience in 1212 Cases.Cancers · 2021Article
- ASO Author Reflections: Laparoscopic Surgery of Perihilar Cholangiocarcinoma Between Oncologic Adequacy and Technical Challenges.Annals of surgical oncology · 2020Article
- Technical Insights on Laparoscopic Left and Right Hepatectomy for Perihilar Cholangiocarcinoma.Annals of surgical oncology · 2020Article
- Perihilar cholangiocarcinoma: are we ready to step towards minimally invasiveness?Updates in surgery · 2020Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The objective of this study is to define the learning curve in a series of procedures grouped according to their complexity calculated by difficulty index to define a standard for technical improvement. 1032 laparoscopic liver resections performed in a single tertiary referral center were stratified by difficulty scores: low difficulty (LD, n = 362); intermediate difficulty (ID, n = 332), and high difficulty (HD, n = 338). The learning curve effect was analyzed using the cumulative sum (CUSUM) method taking into consideration the expected risk of conversion. The ratio of laparoscopic/total liver resections increased from 5.8% (2005) to 71.1% (2018). The CUSUM analysis per group showed that the average value of the conversion rate was reached at the 60th case in the LD Group and at the 15th in the ID and HD groups. The evolution from LD to ID and HD procedures occurred only when learning curve in LD resections was concluded. Reflecting different degree of complexity, procedures showed significantly different blood loss, morbidity, and conversions among groups. A standard educational model-stepwise and progressive-is mandatory to allow surgeons to define the technical and technological backgrounds to deal with a specific degree of difficulty, providing a help in the definition of indications to laparoscopic approach in each phase of training.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.