| 【Background】 The major laparoscopic liver resection (LLR) remains in the exploration phase. Although new surgical techniques have learning curves, safety should be maintained from the onset. Previous studies have assessed major LLRs en bloc, including hepatectomies of varying complexities. This study aimed to identify when and which procedure we should start. 【Methods】 We performed a retrospective review of the operative outcomes of 81 consecutive patients who underwent pure LLR with more than one sectionectomy (except the left lateral sectionectomy). First, the operative outcomes were analyzed using the cumulative sum method (CUSUM). Next, the operative outcomes for each LLR procedure was assessed and compared. 【Results】 The major LLR was introduced after the experience of 60 minor LLRs. The distribution of LLR procedures was as follows: left hemihepatectomy was performed in 28 patients; right hemihepatectomy in 20; central bisectionectomy in 1; right anterior sectionectomy in 10; right posterior sectionectomy in 18; and left medial sectionectomy in 4 patients. The CUSUM for the operative time and the amount of blood loss showed the learning curve, whereas CUSUM for the comprehensive complication index was maintained low level thorough 81 cases. Furthermore, among the LLRs with more than one sectionectomy, the operative time for left hemihepatectomy was the shortest (235 minutes, P <0.001) and the amount of blood loss was the lowest (38 mL, P <0.01). 【Conclusion】 To maintain less complications, 60 minor LLRs could provide adequate experience before the adoption of major LLR. Moreover, the left hemihepatectomy is suitable as a first step in major LLRs because of its accessibility and safety. |
