• Suk Kyun Hong, Kyung-Suk Suh, Kyung Chul Yoon, Jeong-Moo Lee, Jae-Hyung Cho, Nam-Joon Yi, and Kwang-Woong Lee.
• Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongrogu, Seoul, 03080, Republic of Korea.
• Surg Endosc. 2019 Nov 1; 33 (11): 3741-3748.

BackgroundAlthough the use of pure laparoscopic donor hepatectomy (PLDH) is increasingly common, it remains limited to a few experienced centers and no data on the learning curve are currently available. The aim of this study is to evaluate the learning curve associated with the use of pure laparoscopic donor right hepatectomy (PLDRH).MethodsData from donors undergoing PLDRH performed by a single surgeon between November 2015 and October 2017 were retrospectively reviewed. The learning curve was evaluated using the cumulative sum (CUSUM) method based on duration of surgery.ResultsOf 100 donors evaluated, none required transfusion or conversion to open hepatectomy and no irreversible disability or mortality was reported. The mean operative time was 320.7 ± 51.8 min, and all grafts were successfully transplanted. The CUSUM analysis demonstrated a learning curve of approximately 60 cases of PLDRH. Estimated total liver volume > 1400 cm3 and double portal vein orifices were seen to be risk factors for longer surgery time. Having adjusted for case mix with these factors, the risk-adjusted CUSUM analysis demonstrated a learning curve of 65-70 cases of PLDRH.ConclusionsIn conclusion, PLDRH is a feasible and safe procedure with a learning curve of 65-70 cases.

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