Laparoscopic Liver Resections: Are Postero-Superior Liver Segments Really the Last Step of the Learning Curve?

BACKGROUND Posterior-superior (PS) laparoscopic liver resections (LLR) are generally considered the last step of the learning curve (LC). Current literature supports the approach of PS LLR after the completion of a long anterolateral (AL) LC. However, the skills needed for PS LLR are not all achievable with AL LLR. The aim of this study is to explore a new concept of LC for LLR in which AL and PS resection are approached simultaneously.

METHODS This is a retrospective study analyzing LLR performed between 2017 and 2024. PS and AL LLR were approached simultaneously. Two groups of PS and AL LLR were compared, using the textbook outcomes (TO) as the primary outcome. Secondary outcomes were morbidity, conversion, and vascular accidents.

RESULTS The study compares 2 similar groups of 69 PS LLR and 146 AL LLR. PS LLR proved to be longer operations with a higher rate of conversion, but equal in major complications. No significant difference in TO achievement and no major vascular accidents in the PS group were recorded.

DISCUSSION In conclusion, in LLR LC, the simultaneous approach of PS and AL liver resections is safe and feasible. PS LLR are challenging procedures but the achievement of optimal textbook outcome is noninferior to their AL counterpart.