The learning curve of laparoscopic liver resection utilising a difficulty score

Baseline characteristics	N^a,b
Male sex^a	104 (60.8%)
Age (years)^b	64 (20-86, 15)
BMI (kg/m²)^b	27 (18-50, 4.8)
	1 44 (25.7%)
ASA score^a	2 73 (42.7%)
	3 51 (29.8%)
	4 3 (1.8%)
Liver cirrhosis Child-Pugh (22)^a	A 33 (19.3%)
	B 4 (2.3%)
Previous abdominal surgery^a	41 (24.0%)
Previous liver resection^a	8 (4.6%)
Malignant tumour^a	128 (74.9%)
Neoadjuvant chemotherapy^a	25 (14.6%)
Max. diameter (mm)^b	38 (2-160, 33)
Number of tumours^a	1 (1-10, 0).
Deep location within liver^a	50 (29.2%)
Posterosuperior liver segments^a	49 (28.7%)

[i] ^a = categorical variables; ^b = continuous variables have been reported as median (minimum-maximum, interquartile range); ASA = American Society of Anaesthesiologists; BMI = body mass index

Table 2

Perioperative outcomes of 171 patients who underwent laparoscopic liver resection

Intraoperative details and postoperative course	N^a,b
Anatomic resection (23) ^a	101 (59.1%)
Anatomically major resection (23) ^a	27 (15.8%)
Technically major resection (24)^a	29 (17.0%)
Operation time (min)^b	160 (25-450, 90)
Blood loss (mL)^b	150 (0-2200, 180)
Intraoperative complication (10)^c	34 (19.9%)
Conversion to open approach^a	24 (14.0%)
Blood loss > 775 mL^a	12 (7.0%)
Unintentional damage to the surrounding structures^a	2 (1.2%)
Hepatic pedicle clamping^a	45 (26.3%)
Total hepatic pedicle clamping time (min)^b	8 (0-75, 10)
Transfusion required^a	20 (11.7%)
Pathohistological diagnosis
Colorectal liver metastases	53 (31%)
Hepatocellular carcinoma	46 (29.6%)
Intrahepatic cholangiocarcinoma	14 (8.2%)
Other metastases	11 (6.4%)
Hepatic cysts	10 (5.8%)
Hepatic adenoma	6 (4.7%)
Focal nodular hyperplasia	8 (4.7%)
Haemangioma	6 (3.5%)
Other pathology	15 (8.8%)
R0 resection	163 (95.3%)
Major morbidity CD 3a–4b (25)^a	21 (12.3%)
Hospital stay (days)^b	6 (2-79, 4)

[i] ^a = categorical variables; ^b = continuous variables have been reported as median (minimum-maximum, interquartile range); ^c = intraoperative complication was defined as blood loss over 775 mL, unintentional damage to the surrounding structures and conversion to open approach

Histogramic time classes dependency of intraoperative complication (IOC) (yes/no) on the observed cohort.

Time dependency of the Halls difficulty score on the observed cohort (blue points) and its regression (trend) line (red line).

Two types of learning curves for observed cohort and the surgeon under consideration. The orange line (AC) represents the logarithmic regression curve based on absolute complexity. The green line (LC) represents the sum of the orange curve and the quintic regression line of relative complexity. This line represents our learning curve.
AC = absolute complexity; ac (N) = absolute complexity expressed by the number of intraoperative complications; LC = learning curve

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DOI: https://doi.org/10.2478/raon-2021-0035 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099

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Language: English

Page range: 111 - 118

Submitted on: Jun 2, 2021

Accepted on: Jul 16, 2021

Published on: Sep 6, 2021

Published by: Association of Radiology and Oncology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

intraoperative complication

Related subjects:

Medicine,

Clinical medicine,

Radiology

© 2021 Arpad Ivanecz, Irena Plahuta, Matej Mencinger, Iztok Perus, Tomislav Magdalenic, Spela Turk, Stojan Potrc, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 56 (2022): Issue 1 (March 2022)

The learning curve of laparoscopic liver resection utilising a difficulty score

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