Purpose: Despite recent increasing reports on laparoscopic liver resection, it is only being performed at a limited number of institutions due to technical difficulties. This study was performed to evaluate the learning curve for laparoscopic liver resection by analyzing our experiences of laparoscopic left-side liver resection. Methods: A total of 22 cases of total laparoscopic liver resection were performed between May 2003 and October 2004. Of those cases, we selected 16 cases of laparoscopic left-side liver resection (left lateral sectionectomy: 11 cases, left hemihepatectomy: 5 cases). Indications were intrahepatic duct stones (n=10), hepatocellular carcinoma (n=3), and benign tumors (n=3). The cases were divided into sequential two groups of 8. Operative time, intra-operative transfusion, postoperative hospital stay, and complications were analyzed. Results: There were no significant differences in sex, age, indications, and operation type between two groups. Compared with early group, late group was associated with a shorter operation time (456.3 vs. 262.5 minutes, p=0.007), a decreased intra-operative transfusion (2.6 vs. 0.3 units, p=0.083), and a shorter postoperative hospital stay (16.6 vs. 10.3 days, p=0.094). Three cases (37.5%) (sepsis, bile leakage, intra-abdominal fluid collection) of postoperative complications and one case of postoperative mortalitywere present in early group. However, there were no postoperative complication and mortality in late group. Conclusion: Despite a limited number of cases, this study demonstrates that clinical outcome of laparoscopic liver resection was improved by accumulation of experiences. Therefore, we believe that more experiences of laparoscopic liver resection will contribute to overcoming its technical difficulty that limits its wide acceptance.

Keywords: Laparoscopy, Liver resection, Learning curve