Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Transplantation. 2021 Jun 1;105(6):1273-1279. doi: 10.1097/TP.0000000000003344.
This study evaluated the timing of safe introduction of total laparoscopic donor right hepatectomy (TLDRH) based on outcomes of laparoscopic major hepatectomy (LMH).
The data of 1013 consecutive patients who underwent laparoscopic liver resection from 2003 to 2017 were reviewed; the cumulative sum method was used to evaluate the learning curve of LMH. Patients were divided into 3 groups according to the timing of introduction of TLDRH (since 2010) and learning curve of LMH. Surgical outcomes of LMH and TLDRH were evaluated.
Cumulative sum analysis demonstrated a learning curve of approximately 73 cases of LMH. In phase I (before the introduction of TLDRH, 2003-2009), 38 cases of LMH were performed. Phase II (after the introduction of TLDRH until learning curve of LMH, 2010-2014), 35 and 15 cases of LMH and TLDRH were performed, respectively. Phase III (after learning curve of LMH until 2017, 2014-2017), 59 and 20 cases of LMH and TLDRH were performed, respectively. In cases of LMH, there was significant improvement in the operation time 398.9 ± 140.9 versus 403.7 ± 165.2 versus 265.5 ± 91.7; P < 0.001), estimated blood loss (1122.9 ± 1460.2 versus 1209.3 ± 1409.1 versus 359.8 ± 268.8; P < 0.001), and open conversion rate (26.3% versus 22.9% versus 13.6%; P = 0.026) between phases I versus II versus III. In cases of TLDRH, the operation time (567.8 ± 117.9 versus 344.2 ± 71.8; P < 0.001), estimated blood loss (800.7 ± 514.8 versus 439.4 ± 347.0; P = 0.004), and hospital stay (12.5 ± 4.36 versus 9.15 ± 4.84; P = 0.025) significantly improved in phase III.
Overcoming the learning curve of LMH before starting TLDRH is advisable to ensure donor's surgical outcomes.
本研究基于腹腔镜肝切除术（LMH）的结果，评估了全腹腔镜供体右半肝切除术（TLDRH）安全引入的时间。
回顾了 2003 年至 2017 年期间接受腹腔镜肝切除术的 1013 例连续患者的数据；采用累积和法评估 LMH 的学习曲线。根据 TLDRH（自 2010 年以来）的引入时间和 LMH 的学习曲线，将患者分为 3 组。评估 LMH 和 TLDRH 的手术结果。
累积和分析表明，LMH 的学习曲线约为 73 例。在第 I 期（TLDRH 引入前，2003-2009 年），进行了 38 例 LMH。第 II 期（TLDRH 引入后至 LMH 学习曲线，2010-2014 年），分别进行了 35 例和 15 例 LMH 和 TLDRH。第 III 期（LMH 学习曲线后至 2017 年，2014-2017 年），分别进行了 59 例和 20 例 LMH 和 TLDRH。在 LMH 病例中，手术时间有显著改善（398.9±140.9 比 403.7±165.2 比 265.5±91.7；P<0.001）、估计出血量（1122.9±1460.2 比 1209.3±1409.1 比 359.8±268.8；P<0.001）和中转开腹率（26.3%比 22.9%比 13.6%；P=0.026），在 I 期与 II 期与 III 期之间有显著差异。在 TLDRH 病例中，手术时间（567.8±117.9 比 344.2±71.8；P<0.001）、估计出血量（800.7±514.8 比 439.4±347.0；P=0.004）和住院时间（12.5±4.36 比 9.15±4.84；P=0.025）在第 III 期均有显著改善。
在开始 TLDRH 之前克服 LMH 的学习曲线是确保供体手术结果的明智之举。
