A propensity-matched study of full laparoscopic versus hand-assisted minimal-invasive liver surgery
- 1 May 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Surgical Endoscopy
- Vol. 35 (5), 2021-2028
- https://doi.org/10.1007/s00464-020-07597-2
Abstract
Background and aim The implications of multi-incision (MILS) and hand-assisted (HALS) laparoscopic techniques for minimally invasive liver surgery with regard to perioperative outcomes are not well defined. The purpose of this study was to compare MILS and HALS using propensity score matching. Methods 309 patients underwent laparoscopic liver resections (LLR) between January 2013 and June 2018. Perioperative outcomes were analyzed after a 1:1 propensity score match. Subgroup analyses of matched groups, i.e., radical lymphadenectomy (LAD) as well as resections of posterosuperior segments (VII and/or VIII), were performed. Results MILS was used in 187 (65.2%) and HALS in 100 (34.8%) cases, with a significant decrease of HALS resections over time (p = 0.001). There were no significant differences with regard to age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) Score, previous abdominal surgery and cirrhosis between both groups. Patients scheduled for HALS were characterized by a significantly higher rate of malignant tumors (p < 0.001) and major resections (p < 0.001). After propensity score matching (PMS), 70 cases remained in each group and all preoperative variables as well as resection extend were well balanced. A significantly higher rate of radical LAD (p = 0.039) and posterosuperior resections was found in the HALS group (p = 0.021). No significant differences between the matched groups were observed regarding operation time, conversion rate, frequency of major complications, length of intensive care unit (ICU) stay, overall hospital stay and R1 rate. Conclusion Our analysis suggests MILS and HALS to be equivalent regarding postoperative outcomes. HALS might be particularly helpful to accomplish complex surgical procedures during earlier stages of the learning curve.This publication has 33 references indexed in Scilit:
- High incidence of symptomatic incisional hernia after midline extraction in laparoscopic colon resectionSurgical Endoscopy, 2012
- Continuous Improvement of Survival Outcomes of Resection of Hepatocellular CarcinomaAnnals of Surgery, 2011
- Incisional hernia, midline versus low transverse incision: what is the ideal incision for specimen extraction and hand-assisted laparoscopy?Surgical Endoscopy, 2010
- The Learning Curve in Laparoscopic Liver ResectionAnnals of Surgery, 2009
- World Review of Laparoscopic Liver Resection—2,804 PatientsAnnals of Surgery, 2009
- Laparoscopic Major HepatectomyAnnals of Surgery, 2009
- The Clavien-Dindo Classification of Surgical ComplicationsAnnals of Surgery, 2009
- Prediction of Postoperative Outcome After Hepatectomy With a New Bedside Test for Maximal Liver Function CapacityAnnals of Surgery, 2009
- Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 systemJournal of Hepato-Biliary-Pancreatic Surgery, 2005
- Classification of chronic hepatitis: Diagnosis, grading and stagingHepatology, 1994