Shigenori Ei1, Osamu Itano2, Go Oshima1, Masanori Odaira1, Keichiro Kitahama1, Hiroshi Uchida1, Shingo Maeda1, Yasumasa Koyama1, Satoshi Aiko1. 1Department of Surgery, Eiju general hospital, Tokyo, Japan, 2Department of surgery, Keio university, Tokyo, Japan
Background: The availability of laparoscopic hepatectomy remains limited to a relatively small number of institutions because of insufficient hepatic and laparoscopic surgical experience and few training opportunities. At our institute, a particular expert surgeon participates as an operator or an assistant in all laparoscopic hepatectomies and coaches successive trainees. The aim of this study was to assess the feasibility and safety of this training system by reviewing the previous laparoscopic hepatectomy results at our institute.
Methods: One hundred sixty eight laparoscopic hepatectomies were retrospectively reviewed. Patients were divided into four groups: those undergoing surgery by the expert surgeon from April 2006 to March 2011 (80 cases, Group I), those undergoing surgery by trainee A from April 2011 to April 2013 (42 cases, Group II), those undergoing surgery by trainee B from May 2013 to March 2015 (23 cases, Group III), and those undergoing surgery by trainee C from April 2015 to July 2016 (23 cases, Group IV). All trainees had been trained as scopists and assistants of laparoscopic hepatectomy at Keio University hospital for 3 years.
Results: Surgical procedures were major hepatectomy (33 cases, 25 cases, 8 cases, and 2 cases in groups I, II, II and IV, respectively), lateral segmentectomy (6 cases, 1 case, 3 cases, and 1 case, respectively), and partial hepatectomy (41 cases, 16 cases, 12 cases, and 20 cases, respectively). The operative times (min) in each group were as follows: 379 in Group I, 451 in Group II, 321 in Group III, and 248 in Group IV. Estimated blood losses (mL) were 495, 664, 438, and 190, respectively. The first postoperative oral intake days were 14.6, 11.1, 8.1, and 8.7, respectively, and the lengths of hospital stay (days) were 2.4, 3.0, 2.3, and 1.8, respectively. No significant differences were observed among the groups in the rate of postoperative complications with a Clavien–Dindo classification grade of 2 or higher (20.0%, 14.3%, 13.0%, and 13.0%, respectively).
Conclusion: Though it is generally assumed that laparoscopic hepatectomy is a surgical procedure of the highest difficulty, trainees can learn to perform the procedure safely and effectively with intensive tuition provided by an expert.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80095
Program Number: P458
Presentation Session: Poster (Non CME)
Presentation Type: Poster