Comparison of Single-Port Versus Standard Multiport Left Lateral Liver Sectionectomy

Abstract

It remains unclear if single incision laparoscopic liver surgery is superior to standard multiport resections and in what regard patients might benefit from this approach. We retrospectively analyzed the course of all patients undergoing laparoscopic left lateral sectionectomy at our center between 2009 and 2017. In total, 11 single incision and 31 multiport left lateral sectionectomies were performed at our center between July 2009 and May 2017. Six patients were excluded due to multivisceral resections. Indications included adenoma (n = 7 vs n = 2), focal nodular hyperplasia (n = 4 vs n = 3), hepatocellular carcinoma (n = 4 vs n = 4), colorectal liver metastasis (n = 4 vs n = 0), noncolorectal metastasis (n = 2 vs n = 1), hemangioma (n = 3 vs n = 0), abscess (n = 1 vs n = 0), and cysts (n = 1 vs n = 0). Length of operation was significantly shorter in the single incision group (206 vs 137 minutes, P = .003). One complication was observed in the single incision group (grade IIIb, n = 1) while 3 patients in the multiport group suffered from postoperative complications (grade II, n = 1; grade IIIa, n = 2), resulting in a morbidity rate of 12.5% and 11.5%, respectively. No mortality was observed in both groups. Length of hospital stay did not significantly differ in both groups (median 7 vs 7 days, P = .513). The single incision approach is safe and has become the standard approach for the left lateral sectionectomy at our center. Shorter operation times technique might well be due to the easy retrieval of the liver specimen via the umbilical incision with no need for a Pfannenstiel incision.

LaparoEndoscopic Single-Site Upper Gastrointestinal Surgery

“…This difference, however, disappeared in the other two non-randomized matched and unmatched comparisons, when patients with malignant tumours were also included [48,49]. A further advantage observed only by Struecker et al for the LESS technique was shorter operative time, which was attributed to the easy retrieval of the specimen through the umbilical incision [49]. The intraoperative blood loss, conversion, and postoperative morbidity and analgesics requirements were similar between the two groups in all studies.…”

“…Including only patients with benign liver diseases, an RCT demonstrated a significantly shorter length of hospital stay in the LESS group [47]. This difference, however, disappeared in the other two non-randomized matched and unmatched comparisons, when patients with malignant tumours were also included [48,49]. A further advantage observed only by Struecker et al for the LESS technique was shorter operative time, which was attributed to the easy retrieval of the specimen through the umbilical incision [49].…”

“…The intraoperative blood loss, conversion, and postoperative morbidity and analgesics requirements were similar between the two groups in all studies. It was indicated that in wellselected patients with either benign or malignant hepatic lesions, LESS left lateral sectionectomy can provide a safe and effective alternative to multiport laparoscopic surgery [47][48][49].…”

Validity of the Iwate criteria for patients with hepatocellular carcinoma undergoing minimally invasive liver resection

“…Surgery was performed under general anesthesia, and patients were placed in the French position with the surgeon standing between the patients’ legs. Operations were conducted in multiport – (using three to seven laparoscopic ports) in single‐incision – (single umbilical incision) as described previously by our research group . Indications for hand‐assisted techniques were a difficult location of the tumor especially of the posterior segments and complex major resections.…”

Minimally-invasive liver resection for liver tumors in children: a snapshot of the current landscape

“…This allows for greater flexibility when performing combined intra-and extracorporeal reconstructive work or when removing more than one tumor specimen at a time. Although complete hepatectomy has been successfully carried out in adults uniquely through SILS [49] , the authors have no experience nor know of any experience with performing MILR in children exclusively through a SILS port other than for simple atypical resections of peripheral lesions. However, the enclosed space of the pediatric abdominal cavity in children put aside, theoretically there is no reason that such a procedure is technically not feasible.…”