Cognitive task analysis-based education and expansion of pure laparoscopic donor hepatectomy for the next generation: a comparative study of surgical outcomes between expert and fellowship-trained surgeons

Abstract

Background: The implementation of pure laparoscopic donor hepatectomy (PLDH) for adult-to-adult living donor liver transplantation (ALDLT) has largely been confined to experts skilled in both liver transplantation and laparoscopic liver resection (LLR). There is insufficient evidence to support its wider adoption and the training of the next generation of surgeons. This study aimed to evaluate the effectiveness of cognitive task analysis (CTA)-based training in developing technical skills and a professional mindset to enable fellowship-trained surgeons (FTSs) to perform PLDH for ALDLT and to compare surgical outcomes with those of expert surgeons. Methods: The 90-day surgical outcomes of 55 cases of PLDH and ALDLT performed by three FTSs were compared with those from 462 cases performed by one expert surgeon from December 2016 to December 2023 across four institutions. Results: There were no open conversions of PLDH in either group. Donor outcomes, including complication rates and hospital stay, were comparable between the FTS and expert groups, with no donor mortality or biliary stricture in either group. The operation time for PLDH in the FTS group was significantly longer than that in the expert group (338 min vs. 214 min; p < 0.001). In the recipient cohort, there was a significant difference in hepatic vein complications between the FTS and expert groups (5.5% vs. 1.1%; p = 0.043). The 90-day recipient mortality rate in the FTS group was significantly higher than that in the expert group (9.1% vs. 2.4%; p < 0.020). Conclusion: CTA-based education effectively prepares FTSs to perform PLDH by establishing comprehensive strategies for LLR. Further research involving larger sample sizes, and extended follow-up is necessary to optimize recipient outcomes and validate this educational method.