The learning curves in living donor hemiliver graft procurement using small upper midline incision

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• 作者：Toru Ikegami ; Norifumi Harimoto ; Masahiro Shimokawa ; Tomoharu Yoshizumi ; Hideaki Uchiyama ; Shinji Itoh ; Norihisa Okabe ; Kazuhito Sakata ; Akihisa Nagatsu ; Yuji Soejima and Yoshihiko Maehara
• 刊名：Clinical Transplantation
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：30
• 期：12
• 页码：1532-1537
• 全文大小：645K
• ISSN：1399-0012

文摘

The learning curve for performing living donor hemiliver procurement (LDHP) via small upper midline incision (UMI) has not been determined. Living donors (n=101) who underwent LDHP via UMI were included to investigate the learning curve using cumulative sum analysis. The cumulative sum analysis showed that nine cases for right lobe (case #23) and 19 cases for left lobe (case #32 in the whole series) are needed for stable and acceptable surgical outcomes in LDHP via UMI. The established phase (n=69, since case #33) had a significantly shorter operative time, a smaller incision size, and less blood loss than the previous learning phase (n=32, serial case number up to the last 19th left lobe case). Multivariate analysis showed that the learning phase, high body mass index ≥25 kg/m², and left lobe graft procurement are the factors associated with surgical events including operative blood loss ≥400 mL, operative time ≥300 minutes, or surgical complications ≥Clavien-Dindo grade II. There is an obvious learning curve in performing LDHP via UMI, and 32 cases including both 19 cases for left lobe and nine cases for right lobe are needed for having stable and acceptable surgical outcomes.