Impact of First Assistant Surgeon Experience on the Perioperative Outcomes of Laparoscopic Hepatectomies
- PMID: 32109190
- DOI: 10.1089/lap.2019.0701
Impact of First Assistant Surgeon Experience on the Perioperative Outcomes of Laparoscopic Hepatectomies
Abstract
Introduction: This study aims to evaluate the impact of first assistant surgeon experience on the outcomes of laparoscopic hepatectomies in a university-affiliated teaching hospital. Methods: This is a retrospective study comparing outcomes of laparoscopic hepatectomies with first assistant surgeons of varying experience levels. Three hundred and eighty-five consecutive laparoscopic hepatectomies performed in a tertiary university-affiliated teaching hospital from 2012 to 2018 were included and stratified into three cohorts-Group 1 in which assistants were residents, Group 2 for fellows, and Group 3 for attendings. Baseline clinicopathologic variables and outcome measures were analyzed using the augmented inverse probability of treatment weighting approach, which is a propensity score-based method that combines aspects of covariate adjustment and inverse probability weighting. Results: Group 3 comprised a greater proportion of advanced- and expert-level surgeries based on the Iwate criteria; 33.8%, 32.2%, and 46.0% of patients underwent advanced- and expert-level surgeries in Groups 1, 2, and 3, respectively. Group 3 had consistently higher operative times as well as more frequent use and longer duration of Pringle's maneuver (P < .05). The median operative times for Groups 1, 2, and 3 were 195, 195, and 290 minutes, respectively. Pringle's maneuver was applied in 26.9%, 33.9%, and 60.2% of patients with a corresponding median duration of 35, 36, and 45 minutes, respectively. None of the other perioperative and postoperative outcomes demonstrated statistically significant differences. Conclusion: With an appropriate selection of cases, participation of residents as first assistants in laparoscopic hepatectomies can be encouraged without compromise in perioperative outcomes.
Keywords: assistant experience; hepatectomy; laparoscopic; liver resection; minimally invasive surgery; outcomes.
Similar articles
-
Minimally Invasive vs Open Major Hepatectomies for Liver Malignancies: a Propensity Score-Matched Analysis.J Gastrointest Surg. 2022 May;26(5):1041-1053. doi: 10.1007/s11605-021-05226-4. Epub 2022 Jan 21. J Gastrointest Surg. 2022. PMID: 35059983
-
Minimally invasive versus open right hepatectomy: comparative study with propensity score matching analysis.BMC Surg. 2020 Oct 30;20(1):260. doi: 10.1186/s12893-020-00919-0. BMC Surg. 2020. PMID: 33126885 Free PMC article.
-
Changing trends and outcomes associated with the adoption of minimally invasive hepatectomy: a contemporary single-institution experience with 400 consecutive resections.Surg Endosc. 2018 Nov;32(11):4658-4665. doi: 10.1007/s00464-018-6310-1. Epub 2018 Jul 2. Surg Endosc. 2018. PMID: 29967997
-
Critical appraisal of the learning curve of minimally invasive hepatectomy: experience with the first 200 cases of a Southeast Asian early adopter.ANZ J Surg. 2020 Jun;90(6):1092-1098. doi: 10.1111/ans.15683. Epub 2020 Jan 20. ANZ J Surg. 2020. PMID: 31957149 Review.
-
Minimally invasive major hepatectomies: a Southeast Asian single institution contemporary experience with its first 120 consecutive cases.ANZ J Surg. 2020 Apr;90(4):553-557. doi: 10.1111/ans.15563. Epub 2019 Nov 12. ANZ J Surg. 2020. PMID: 31721400 Review.
Cited by
-
A multidimensional learning curve analysis of totally laparoscopic ileostomy reversal using a single surgeon' s experience.Front Surg. 2023 Feb 13;10:1077472. doi: 10.3389/fsurg.2023.1077472. eCollection 2023. Front Surg. 2023. PMID: 36860945 Free PMC article.
-
Does the experience of the first assistant affect organ injuries in laparoscopic hysterectomy for benign diseases?Arch Gynecol Obstet. 2023 Feb;307(2):453-458. doi: 10.1007/s00404-022-06745-4. Epub 2022 Sep 1. Arch Gynecol Obstet. 2023. PMID: 36045193 Free PMC article. Review.
MeSH terms
LinkOut - more resources
Full Text Sources
Medical