ArticleSurgical endoscopy2026
Multimodal analysis of the learning curve for pure laparoscopic donor right hepatectomy in a low-volume transplant center: a comparative cohort study.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe adoption of pure laparoscopic donor right hepatectomy (PLDRH) has been limited by a perceived steep learning curve, traditionally estimated at 60-70 cases. This study evaluates whether "second-generation" laparoscopic surgeons can achieve proficiency more rapidly in a low-volume transplant center using structured training and standardized techniques.
methodsWe analyzed 29 consecutive, non-selective PLDRH cases performed by a single surgeon. A multimodal CUSUM analysis, incorporating operative time, estimated blood loss, and the Comprehensive Complication Index, was used to define the learning curve, alongside a donor complexity score. Outcomes were compared with a cohort of 21 conventional open donor right hepatectomies.
resultsA three-phase learning progression was identified. Competency and proficiency were reached at cases 10 and 20, respectively. Phase 2 (cases 11-20) was characterized by a "second learning curve" as the team encountered more complex anatomical variations within the consecutive cohort. By Phase 3 (cases 21-29), surgical metrics stabilized with zero complications, even as case complexity increased. Compared to CODRH, the PLDRH group achieved similar safety profiles but significantly shorter hospital stays (p < 0.05).
conclusionsPLDRH can be safely implemented in low-volume centers with an accelerated learning curve. For surgeons with prior advanced laparoscopic expertise, institutional proficiency may be achieved within 20 cases. These findings suggest that standardized "second-generation" approaches may broaden the accessibility of laparoscopic donor surgery without compromising safety.
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