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Background <p>The adoption of pure laparoscopic donor right hepatectomy (PLDRH) has been limited by a perceived steep learning curve, traditionally estimated at 60–70 cases. This study evaluates whether “second-generation” laparoscopic surgeons can achieve proficiency more rapidly in a low-volume transplant center using structured training and standardized techniques.</p> Methods <p>We analyzed 29 consecutive, non-selective PLDRH cases performed by a single surgeon. A multimodal CUSUM analysis, incorporating operative time, estimated blood loss, and the Comprehensive Complication Index, was used to define the learning curve, alongside a donor complexity score. Outcomes were compared with a cohort of 21 conventional open donor right hepatectomies.</p> Results <p>A three-phase learning progression was identified. Competency and proficiency were reached at cases 10 and 20, respectively. Phase 2 (cases 11–20) was characterized by a “second learning curve” as the team encountered more complex anatomical variations within the consecutive cohort. By Phase 3 (cases 21–29), surgical metrics stabilized with zero complications, even as case complexity increased. Compared to CODRH, the PLDRH group achieved similar safety profiles but significantly shorter hospital stays (<i>p</i> &lt; 0.05).</p> Conclusions <p>PLDRH can be safely implemented in low-volume centers with an accelerated learning curve. For surgeons with prior advanced laparoscopic expertise, institutional proficiency may be achieved within 20 cases. These findings suggest that standardized “second-generation” approaches may broaden the accessibility of laparoscopic donor surgery without compromising safety.</p>

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Multimodal analysis of the learning curve for pure laparoscopic donor right hepatectomy in a low-volume transplant center: a comparative cohort study

  • 期刊论文

  • 发表日期：

    2026年7月27日

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  • Thanathorn Jearanaikulvanich,
  • Asara Thepbunchonchai,
  • Sunhawit Junrungsee,
  • Anon Chotirosniramit,
  • Kanya Udomsin,
  • Warangkana Lapisatepun,
  • Phuriphong Chanthima,
  • Worakitti Lapisatepun

摘要

Background

The adoption of pure laparoscopic donor right hepatectomy (PLDRH) has been limited by a perceived steep learning curve, traditionally estimated at 60–70 cases. This study evaluates whether “second-generation” laparoscopic surgeons can achieve proficiency more rapidly in a low-volume transplant center using structured training and standardized techniques.

Methods

We analyzed 29 consecutive, non-selective PLDRH cases performed by a single surgeon. A multimodal CUSUM analysis, incorporating operative time, estimated blood loss, and the Comprehensive Complication Index, was used to define the learning curve, alongside a donor complexity score. Outcomes were compared with a cohort of 21 conventional open donor right hepatectomies.

Results

A three-phase learning progression was identified. Competency and proficiency were reached at cases 10 and 20, respectively. Phase 2 (cases 11–20) was characterized by a “second learning curve” as the team encountered more complex anatomical variations within the consecutive cohort. By Phase 3 (cases 21–29), surgical metrics stabilized with zero complications, even as case complexity increased. Compared to CODRH, the PLDRH group achieved similar safety profiles but significantly shorter hospital stays (p < 0.05).

Conclusions

PLDRH can be safely implemented in low-volume centers with an accelerated learning curve. For surgeons with prior advanced laparoscopic expertise, institutional proficiency may be achieved within 20 cases. These findings suggest that standardized “second-generation” approaches may broaden the accessibility of laparoscopic donor surgery without compromising safety.