Abstract
Background: Bleeding is a negative outcome predictor in liver surgery. Reduction in the abdominal wall trauma in major hepatectomy is challenging but might offer possible benefits for the patient. This study was conducted to assess hemostasis techniques in single-port major hepatectomies (SP-MajH) as compared to multiport major hepatectomies (MP-MajH). Methods: The non-randomized study comprised 34 SP-MajH in selected patients; 14 MP-MajH served as the control group. Intraoperative blood loss and number of blood units transfused served as the primary endpoints. Secondary endpoints were complications and oncologic five-year outcome. Results: All resections were completed without converting to open surgery. Time for hepatectomy did not differ between SP-MajH and MP-MajH. Blood loss and number of patients with blood loss > 25 mL were significantly larger in MP-MajH (p = 0.001). In contrast, bleeding control was more difficult in SP-MajH, resulting in more transfusions (p = 0.008). One intestinal laceration (SP-MajH) accounted for the only intraoperative complication; 90-day mortality was zero. Postoperative complications were noted in total in 20.6% and 21.4% of patients for SP-MajH and MP-MajH, respectively. No incisional hernia occurred. During a median oncologic follow-up at 61 and 56 months (SP-MajH and MP-MajH), no local tumor recurrence was observed. Conclusions: SP-MajH requires sophisticated techniques to ensure operative safety. Substantial blood loss requiring transfusion is more likely to occur in SP-MajH than in MP-MajH.
Highlights
The scientifically proven benefits of minimally invasive liver surgery justify the effort to further develop the technique [1]
Demographic parameters of patients undergoing single-port major hepatectomies (SP-MajH) and multiport major hepatectomies (MP-MajH) are summarized in Table 1 (Tab 1); procedural parameters are summarized in Table 2 (Tab 2)
All major liver resections were able to be performed with the particular laparoscopic technique without converting to open surgery
Summary
The scientifically proven benefits of minimally invasive liver surgery justify the effort to further develop the technique [1]. Single-port laparoscopy (SP) is regarded as the most ambitious approach to minimize abdominal wall trauma in hepatic resection. As compared to multiport laparoscopy, SP liver surgery is advantageous in terms of reduced blood loss while providing the same effectiveness and optimal patient safety and recovery [4]. Due to the technical obstacles encountered, such as the combination of different instruments that have to be delivered simultaneously through one single fulcrum to expose the operation field and to provide suction, flushing, coagulation or clipping, SP major hepatic resection (SP-MajH) is not performed at most liver centers. Intraoperative blood loss and number of blood units transfused served as the primary endpoints. Substantial blood loss requiring transfusion is more likely to occur in SP-MajH than in MP-MajH
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