An innovative approach for laparoscopic liver resections. Training protocol

Abstract

AIM: To evaluate the benefits of systematical use of ex vivo liver model and CT imaging in the planning process for swine laparoscopic liver resections done by residents during a dedicated training program.

MATERIAL AND METHODS: Thirty general surgery residents, part of a dedicated and continuous training program, were equally divided into two groups: first one which performed laparoscopic liver resections without planning stage and the second one which systematically used an interactive tutorial for establishing the strategy for the resection followed by performing open liver dissection and the same resection on an ex vivo swine model. Afterwards, laparoscopic procedures were performed on twenty anesthetized domestic pigs.

RESULTS: All teams successfully completed the procedure, with no conversions to open approach and without trainers’ intervention. The second group was faster than the first group on both minor and major resections (p=0.0001). The blood loss was significantly lower on the second group (p=0.005).

DISCUSSION: The residents surpassed our expectations regarding the operation time, blood loss and conversions, validating our training program. The step-by-step program was developed using the IDEAL paradigm, being now at the end of the 2b phase (exploration), when the residents realize the benefits of this model. The reduction in blood loss and loss of functional parenchyma demonstrates the utility of a warming-up phase.

CONCLUSIONS: The “warming up” by adding the imagistic and anatomical data to the core protocol offer more clarity before laparoscopic liver resections and makes an upgrade for our “step by step” protocol.