Abstract
Background: The aim of the present study is to evaluate the differential benefit of laparoscopic over open technique according to the technical difficulty of the procedures and to define - according to this parameter - the strength of commitment to minimally invasive approach. Material and Methods: 936 MILS resections performed between 2005 and 2018 were stratified according to technical complexity (Low, Intermediate and High difficulty) and to approach (MILS or open) and then matched in a 1:1 ratio using propensity scores to obtain three pairs of groups (Pair 1:Low-MILS and Low-Open, including 274 cases respectively; Pair 2: Int-MILS and Int-Open, including 237 patients respectively; Pair 3: High-MILS and High-Open, including 226 patients respectively). Blood loss, postoperative morbidity and time for functional recovery were chosen as outcome indicators to calculate the differential benefit among pairs. Results: Within pairs, preoperative characteristics of patients and disease were comparable between MILS and open approach. MILS approach resulted in a statistically significant lower blood loss, reduced morbidity, reduced and shorter time for functional recover and length of stay within all pairs. Reflecting different degree of complexity, procedures showed significantly different blood loss, morbidity, rate of conversion and time for functional recovery among different Pairs. The evaluation of the differential benefit showed a greater advantage of laparoscopic approach in High degree procedures compared with Intermediate and Low degree, both in terms of blood loss (-250 mL and -200 mL respectively) and morbidity rate (-5.7% and -4.1% respectively). Conclusion: The favorable biological scenario associated with laparoscopic approach allows to obtain significant benefits in the setting of technically complex procedures, constituting the prerequisite for an adequate surgical outcome. The commitment towards MILS approach should be therefore stronger in this setting, where - overcome the limit of technical challenges - the advantage of laparoscopy seems to be enhanced.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
