Minimally Invasive Hepatectomy Research Articles

Donor Safety for Minimal invasive Hepatectomy in Liver transplantation;The Korean Organ Transplantation Registry

Donor Safety for Minimal invasive Hepatectomy in Liver transplantation;The Korean Organ Transplantation Registry

Donor safety for minimal invasive hepatectomy in liver transplantation: the Korean Organ Transplantation Registry

Background: The most important concern in living donor liver transplantation (LDLT) is donor safety. Although minimally invasive living donor surgery has been increasingly accepted, its safety remains to be fully clarified in a large-scale study. This study evaluated the safety and effectiveness of minimal invasive living donor hepatectomy in comparison with conventional open procedure using Korean Organ Transplantation Registry data. Methods: We reviewed the prospectively collected data of all 1694 living liver donors who underwent procedures between April 2014 and December 2017. We allocated the donors to a minimal invasive group (MIG, n = 304) and a open group (OG, n = 1390) and analyzed the relations clinical data and complications. Results: The median follow-up was 31 months. During the study period, 1071 men and 623 women donated livers and there were no deaths after living liver donation. The overall complication rates were 7.3% and 4.5% in the two group. (p = 0.43) In the MIG, the AST level at I year after donation was lower than OG (20.4 ± 5.5 mg/dL versus 22.4 ± 9.1 mg/dL, p = 0.003) On the hand, the total bilirubin level at 6 months after donation was higher (0.84 ± 0.39 mg/dL versus 0.74 ±0.36 mg/dL, P < 0.001)The MIG was shorter than OG in duration of hospitalization. (9.04 ± 3.78 days versus 10.29 ± 4.01 days, p < 0.001) Conclusions: The minimal invasive donor hepatectomy was relatively some higher complication rate which was no statistically significant difference but lower duration of hospitalization in compare to conventional open procedure in our study.

Changing trends and outcomes associated with the adoption of minimally invasive hepatectomy: a contemporary single-institution experience with 400 consecutive resections.

Several studies published mainly from pioneers and early adopters have documented the evolution of minimally invasive hepatectomy (MIH). However, questions remain if these reported experiences are applicable and reproducible today. This study examines the changing trends, safety, and outcomes associated with the adoption of MIH based on a contemporary single-institution experience. This is a retrospective review of 400 consecutive patients who underwent MIH between 2006 and 2017 of which 360 cases (90%) were performed since 2012. To determine the evolution of MIH, the study population was stratified into four equal groups of 100 patients. Analyses were also performed of predictive factors and outcomes of open conversion. Four hundred patients underwent MIH of which 379 (94.8%) were totally laparoscopic/robotic. Eighty-eight (22.0%) patients underwent major hepatectomy and 160 (40.0%) had resection of tumors located in the posterosuperior segments. There were 38 (9.5%) open conversions. Comparison across the four groups demonstrated that patients were older, had higher ASA score, and had increased frequency of previous abdominal surgery and repeat liver resections. There was also an increase in the proportion of patients who underwent totally laparoscopic/robotic surgery, major liver resection, resection of ≥ 3 segments, and multiple resections. Comparison of outcomes demonstrated that there was a significant decrease in open conversion rate, longer operation time, and increased use of Pringles maneuver. The presence of cirrhosis and institution experience (1st 100 cases) were independent predictors of open conversion. Patients who required open conversion had significantly increased operation time, blood loss, blood transfusion rate, morbidity, and mortality. The case volume of MIH performed increased rapidly at our institution over time. Although the indications of MIH expanded to include higher risk patients and more complex hepatectomies, there was a decrease in open conversion rate and no change in other perioperative outcomes.

Hand-assisted minimally invasive hepatectomy for malignant indications is superior to the totally laparoscopic approach

Objective: This project was designed to critically assess the outcomes of hand-assisted laparoscopic minimally-invasive hepatectomy for malignancy. Methods: Eighty-two consecutive patients undergoing minimally invasive hepatectomy for malignancy were assessed for intraoperative, pathological, mid-term complications and long-term oncologic outcomes. The median age was 59 years (range: 24–79 yrs), 54% were male, and the median BMI was 27.1 (IQR: 24.2–31.8). Sixty-eight patients (83%) had hand-assisted resection (Gelport, Applied Medical) via an 8 cm port/extraction incision (36 subcostal/32 midline) and 14 (17%) were totally laparoscopic. Histologies included colorectal metastases (55%), HCC (17%), NET metastases (6%), and other malignancy (22%) with 45% treated with preoperative chemotherapy. Results: Median operative time was 200 minutes (IQR: 155–244 min) and median EBL was 88cc (IQR: 50–150cc) with no perioperative transfusions. There was one conversion to open surgery for extensive portal inflammation after PVE. Six patients (9%) in the hand-assisted group had small occult tumors identified by palpation and resected, none of which were detectable on imaging or ultrasound. Postoperatively, there were 11 patients (13%) with minor complications, no major complications, no reoperations, 4 readmissions (5%) and no 90-day mortalities. 95% of resections were R0 with no intrahepatic recurrence in the four R1 cases. With a median follow-up of 18 months, the 3-year RFS was 58% with 68% of patients without disease and the 3-year OS was 82%. Conclusion: Compared to historical totally laparoscopic hepatectomy outcomes with a pfannenstiel extraction incision, upper abdominal hand-assisted laparoscopic hepatectomy is safer, more efficient, and better able to identify small occult lesions, while providing excellent oncologic outcomes.

Long-Term Oncological Safety of Minimally Invasive Hepatectomy in Patients with Hepatocellular Carcinoma: A Case-Control Study

Minimally invasive hepatectomy (MIH) for patients with hepatocellular carcinoma (HCC) is technically challenging, especially with large posteriorly located tumours or background of liver cirrhosis. This is a case-control study comparing the long-term oncological safety of HCC patients who underwent MIH and open hepatectomy (OH). Most of these patients have liver cirrhosis compared to other studies. Sixty patients were divided into 2 groups, 30 underwent MIH and 30 underwent OH for HCC resection. The patients in both groups were matched for extent of tumour resection, age and cirrhosis status. Patient characteristics, risk factors of HCC and all oncological data were studied. Negative resection margins were achieved in 97% of patients in both groups. The mean blood loss during surgery was significantly lower in the MIH group compared to the OH group (361 mL vs 740 mL; 95% CI, 222.2, 734.9; P = 0.04). Hospitalisation is significantly shorter in MIH group (7 days vs 11 days; 95% CI, 6.9, 12.2,; P = 0.04). Eight patients (27%) in the MIH group and 13 patients (43%) in the OH group developed HCC recurrence (P = 0.17). One, 3 and 5 years disease-free survival between MIH and OH groups are 76% vs 55%, 58% vs 47%, and 58% vs 39% respectively (P = 0.18). One, 3 and 5 years overall survival between MIH and OH groups are 93% vs 78%, 89% vs 70%, and 59% vs 65% respectively (P = 0.41). MIH is a safe and feasible curative treatment option for HCC with similar oncological outcomes compared to OH. MIH can be safely performed to remove tumours larger than 5 cm, in cirrhotic liver, as well as centrally and posterior located tumours. In addition, MIH patients have significant shorter hospitalisation and intraoperative blood loss.

Meta-Analysis of Trials Comparing Minimally-Invasive and Open Liver Resections for Hepatocellular Carcinoma

Recent literature suggests that minimally-invasive hepatectomy (MIH) for hepatocellular carcinoma (HCC) is associated with better perioperative results and similar oncologic outcomes compared to open hepatectomy (OH). However, previous reports have been limited by small sample size and single-institution design. To overcome these limitations, we performed a meta-analysis of studies comparing MIH and OH in patients with HCC using a random-effects model. Nine eligible studies were identified that included 227 patients undergoing MIH and 363 undergoing OH. Patients were similar respect to age, gender, rates of cirrhosis, hepatitis C infection, tumour size, and American Society of Anesthesiology classification. The MIH group had lower rates of hepatitis B infection. There were no differences in type of resection (anatomic or non-anatomic), use of Pringle's maneuver, and operative time. Patients undergoing MIH had less blood loss [difference -217 mL; 95% confidence interval (CI), -314 to -121], lower rates of transfusion [odds ratio (OR), 0.38; 95% CI, 0.24 to 0.59], shorter postoperative stay (difference -5 days; 95% CI, -7.84 to -2.25), lower rates of positive margins (OR, 0.30; 95% CI, 0.12 to 0.69) and perioperative complications (OR, 0.45; 95% CI, 0.31 to 0.66). Survival outcomes were similar in the two groups. Although patient selection might have influenced some of the observed outcomes, MIH was associated with decreased blood loss, transfusions, rates of positive resection margins, overall and specific morbidity, and hospital stay. Survival outcomes did not differ between MIH and OH, although further studies are needed to evaluate the impact of MIH on long-term results.

Minimal invasive hepatectomy (MIH) using a microwave coagulator for cirrhotic patient with small hepatocellular carcinoma

Surgical resection is the optimal treatment for hepatocellular carcinoma (HCC), however, in patients with liver cirrhosis, major hepatectomy is dangerous because of impaired liver function. We performed partial resection of the liver using microwave tissue coagulator (minimal invasive hepatectomy : MIH) in 14 cirrhotic patients with HCC smaller than 3 cm in diameter. Among 14 patients, 10 patients had hepatectomy with thoraco-abdominal approach. The blood loss during operation was 247 ± 95 ml, and only one patient had allogenic blood transfusion. We had not experienced postoperative major complications, and mean postoperative hospital stay was 18.5 ± 7.4 days. The serum interleukin-6 level at 1st postoperative day was 176 ± 48 pg/ml, which was significantly (p<0.05) lower than that in patients with major hepatectomy for HCC. Thus the partial resection of the liver using a microwave coagulator is considered to be less invasive, safe and useful method for cirrhotic patient with small HCC.