*Purpose: Living donor liver transplantation (LDLT) is an important method in reducing wait list mortality. Laparoscopic hepatectomy has been investigated in order to decrease donor morbidity, and laparoscopic left lateral sectionectomy (LLLS) has shown excellent outcomes at a few centers throughout the world. However, LLLS has not been widely adopted due to safety and technical concerns, and thus its learning curve remains undefined. In this study, we aim to evaluate its feasibility and the number of cases required to reach proficiency.

*Methods: Prospectively collected data of 37 consecutive LLLS from 2009 to 2018 at our institution was analyzed. Operative time (OT) and estimated blood loss (EBL) for each case were plotted chronologically to reflect their trend. The learning curve was determined by applying cumulative sum (CUSUM) methodology for both OT and EBL.

*Results: OT and EBL decreased with experience and best trended with exponential curve (Figure 1a/2a). Median OT was 321 (244-427) minutes and median EBL was 150 (50-600) cc. The CUSUM learning curves were best approximated as a second order polynomial for both OT and EBL with R²=0.566-0.765 (Figure 2a/2b). CUSUM analysis reached to proficiency at 14 and 15 cases for EBL and OT, respectively. Mortality was 0%, and morbidity was 8% (Clavien-Dindo grade 3; 2 bile leak and 1 incisional hernia) with median follow-up of 23.5 months.

*Conclusions: The study suggests the living donor laparoscopic left lateral sectionectomy is safe, feasible, and reproducible procedure. Learning curve effect indicates that 14-15 LLLS cases are required in order to best reduce OT and EBL and to reach learning curve plateau. With appropriate direction and supervision by experienced surgeons, LLLS can be reasonably and safely performed in LDLT.

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