MILS in a general surgery unit: learning curve, indications, and limitations.
Journal:
Updates in surgery
Published Date:
Jul 12, 2015
Abstract
Minimally invasive liver surgery (MILS) is going to be a method with a wide diffusion even in general surgery units. Organization, learning curve effect, and the environment are crucial issues to evaluate before starting a program of minimally invasive liver resections. Analysis of a consecutive series of 70 patients has been used to define advantages and limits of starting a program of MILS in a general surgery unit. Seventeen MILS have been calculated with the cumulative sum method as the number of cases to complete the learning curve. Operative times [270 (60-480) vs. 180 (15-550) min; p 0.01] and rate of conversion (6/17 vs. 5/53; p 0.018) decrease after this number of cases. More complex cases can be managed after a proper optimization of all steps of liver resection. When a high confidence of the medical and nurse staff with MILS is reached, economical and strategic issues should be evaluated in order to establish a multidisciplinary hepatobiliary unit independent from the general surgery unit to manage more complex cases.
Authors
Keywords
Adult
Aged
Aged, 80 and over
Blood Loss, Surgical
Clinical Competence
Cohort Studies
Female
Follow-Up Studies
General Surgery
Hepatectomy
Hospital Units
Humans
Laparoscopy
Learning Curve
Length of Stay
Male
Middle Aged
Operating Rooms
Operative Time
Quality of Health Care
Retrospective Studies
Risk Assessment
Robotics
Treatment Outcome