Benefits of hand-assisted laparoscopic hepatectomy

Abstract

Background: Hand-assisted laparoscopic hepatectomy (HALH) has been considered as the intermediate procedure to safely evolve from open to completely laparoscopic liver resection. Although the concept of performing an incision might cause the disadvantage of the minimally-invasive procedure, it provides the possibility of a manual mobilization, parenchymal and vascular clamping for safety control as well as access to a non-laparoscopic US device. The aim of this study is evaluate the results of HALH compared to the standard open (OpenH) procedure at a single center Methods: A retrospective paired match control study (1 HALH: 1 OpenH) was performed. Completely laparoscopic procedures were excluded of the analysis. Results: Between August 2010 and December 2016: 284 hepatectomies were performed.31 were HALH were match with 31 open hepatectomías for: procedure, age, sex, indication of surgery and type of resection. Types of primary diagnoses were: 43% malignant tumors for open hepatectomies and 38.7% for HALH. Mean Op time, Mayor complications rate, ICU stay and Length of Hospital stay, and mortality. M/F ratio: for HALH vs Open H group; [Table 1] shows the most relevant data. There were no statistical differences for post-op liver biochemistries 48 hrs after the surgery. There was no difference in 90 days mortality rate. Conclusion: The HALH maintains the advantages of pure laparoscopic hepatectomy, reducing major's complications and hospital stay, allowing a faster track to return to their daily activities.Table 1Age (yrs)Min/May res.Op time (Min)Complic.ICU StayLength of H. stayHALH (31)56 ± 1532,3/17,7%263 ± 12925.8%1.4 + 0 62.7 ± 1.25OpenH(31)62 ± 11*33,9/16,1%285 ± 1013.3%**2.6 + 2#4.61 ± 3.7##*p=0.06, **p=0.02; #p=0.005; ###p=0.013 Open table in a new tab *p=0.06, **p=0.02; #p=0.005; ###p=0.013