Learning curves in minimally invasive hepatectomy: systematic review and meta-regression analysis

2021/01/01 by Darren Chua, Darren W. Chua, Nicholas Syn +4 · 134 citations
Medicine · Physics and Astronomy · #Advanced Radiotherapy Techniques #Hepatectomy #Hepatocellular Carcinoma Treatment and Prognosis #Internal medicine #MEDLINE #Medicine #Meta-analysis #Meta-regression #Organ Transplantation Techniques and Outcomes #Surgery

paper · doi:10.1093/bjs/znaa118

published in British journal of surgery 108(4), 351-358 (Oxford University Press)

openalex publication_date 2021/01/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/30

Abstract

BACKGROUND: Minimally invasive hepatectomy (MIH) has become an important option for the treatment of various liver tumours. A major concern is the learning curve required. The aim of this study was to perform a systematic review and summarize current literature analysing the learning curve for MIH. METHODS: A systematic review of the literature pertaining to learning curves in MIH to July 2019 was performed using PubMed and Scopus databases. All original full-text articles published in English relating to learning curves for both laparoscopic liver resection (LLR), robotic liver resection (RLR), or a combination of these, were included. To explore quantitatively the learning curve for MIH, a meta-regression analysis was performed. RESULTS: Forty studies relating to learning curves in MIH were included. The median overall number of procedures required in studies utilizing cumulative summative (CUSUM) methodology for LLR was 50 (range 25-58) and for RLR was 25 (16-50). After adjustment for year of adoption of MIH, the CUSUM-derived caseload to surmount the learning curve for RLR was 47.1 (95 per cent c.i. 1.2 to 71.6) per cent; P = 0.046) less than that required for LLR. A year-on-year reduction in the number of procedures needed for MIH was observed, commencing at 48.3 cases in 1995 and decreasing to 23.8 cases in 2015. CONCLUSION: The overall learning curve for MIH decreased steadily over time, and appeared less steep for RLR compared with LLR.

Citations

• The International Position on Laparoscopic Liver Surgery
• World Review of Laparoscopic Liver Resection—2,804 Patients
• The Learning Curve in Laparoscopic Liver Resection
• Laparoscopic Versus Open Resection for Colorectal Liver Metastases
• Survival Advantage of Laparoscopic Versus Open Resection For Colorectal Liver Metastases

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