Application value of the adhesive suspension of left lateral lobe of liver in transumbilical single-port laparoscopic left upper abdominal surgery

Abstract

Objective To investigate the application value of the adhesive suspension of left lateral lobe of liver in transumbilical single-port laparoscopic left upper abdominal surgery. Methods The retrospective cross-sectional study was conducted. The clinical data of 112 patients who underwent single-port laparoscopic left upper abdominal surgery in the Shengjing Hospital of China Medical University between January 2010 and October 2016 were collected. Patients underwent single-port laparoscopic left upper abdominal surgery, and intraoperative surgical fields were exposed through adhesive suspension of left lateral lobe of liver. Observation indicators: (1) intraoperative situations: surgical completion, surgical procedures, time of liver adhesive suspension, total operation time and intraoperative liver adhesive suspension-related complications; (2) postoperative situations: pre- and post-operative alanine transaminase (ALT) and aspartate transaminase (AST) levels, hospital expenses and duration of hospital stay; (3) follow-up: number of patients with follow-up, follow-up time, complications during follow-up. Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications up to June 2017. Measurement data with normal distribution were represented as ±s. Repeated measurement data were analyzed using the repeated measures ANOVA. Results (1) Intraoperative situations: 112 patients underwent successfully single-port laparoscopic left upper abdominal surgery, without conversion to multi-port surgery or open surgery. Of 112 patients, 30, 23, 13, 11, 11, 10, 3, 3, 3, 3, 1 and 1 underwent radical resection of gastric cancer, partial gastrectomy, esophageal Heller myotomy + Dor fundo-plication, subtotal gastrectomy, resection of body and tail of pancreas, paraoesophageal hiatal hernia repair + fundoplication, total gastrectomy, splenectomy, splenectomy + devascularization, pancreatic tail resection, simple fundoplication and splenic artery aneurysm resection, respectively. Time of liver adhesive suspension and total operation time in 112 patients were respectively (1.4±0.4)minutes and (192.0±91.3) minutes. There was no hepatic laceration, hepatic subcapsular hematoma and other complications. (2) Postoperative situations: of 112 patients, preoperative ALT and AST levels of 6 patients were mildly elevated, postoperative ALT and AST levels in 2 of 6 patients returned to normal, that in 1 of 6 patients were elevated at day 1 postoperatively and returned to normal at day 3 postoperatively, and that in 2 of 6 patients remained mildly elevated at week 1 postoperatively; preoperative ALT and AST levels of 106 patients were normal, ALT and AST levels in 31 of 106 patients were elevated at day 1 postoperatively (that in 28 patients returned to normal within week 1 postoperatively, and that in 3 patients remained mildly elevated), and that in 75 of 106 patients returned to normal. ALT and AST levels of 112 patients were (16±11)U/L, (18±7)U/L before operation and (31±21)U/L, (34±26)U/L at day 1 postoperatively and (19±17)U/L, (19±12)U/L at week 1 postoperatively, respectively, with statistically significant differences in ALT and AST levels before operation and at day 1 postoperatively (F=36.353, 29.792, P 0.05). Hospital expenses, surgery-related expenses and duration of hospital stay were (45 231±20 440)yuan, (23 511±9 609)yuan and (6.0±1.9)days, respectively. (3) Follow-up: 112 patients were followed up for 1.0-3.0 months, with a median time of 1.6 months. During the follow-up, there were no obvious complications. Conclusion Adhesive suspension of left lateral lobe of liver is simple and safe, with satisfactory exposure effects, and it is suitable for the better operative field exposure in single-port laparoscopic left upper abdominal surgery. Key words: Gastric neoplasms; Left lateral lobe of liver; Suspension, adhesive; Left hypochondriac region; Laparoscopy, single-port