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Laparoscopic liver surgery: towards a day-case management

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Abstract

Background

Ambulatory surgery (AS) is a contemporary subject of interest. The feasibility and safety of AS for solid abdominal organs are still dubious. In the present study, we aimed at defining potential surgical criteria for AS by analyzing a large database of patients who underwent laparoscopic liver surgery (LLS) in two French expert centers.

Methods

This study was performed using prospectively filled databases including patients that underwent pure LLS between 1998 and 2015. Patients whose perioperative medical characteristics (ASA score <3, no associated extra-hepatic procedure, surgical duration ≤180 min, blood loss ≤300 mL, no intraoperative anesthesiological or surgical complication, no postoperative drainage) were potentially adapted for ambulatory LLS were included in the analysis. In order to determine the risk factors for postoperative complications, multivariate analysis was carried out.

Results

During the study period, pure LLS was performed in 994 patients. After preoperative and intraoperative characteristics screening, 174 (17.5%) patients were considered for the final analysis. Lesions (benign (46%) and liver metastases (43%)) were predominantly single with a mean size of 37 ± 32 mm in an underlying normal or steatotic liver parenchyma (94.8%). The vast majority of LLS performed were single procedures including wedge resections and liver cyst unroofing or left lateral sectionectomies (74%). The global morbidity rate was 14% and six patients presented a major complication (Dindo–Clavien ≥III). The mean length of stay was 5 ± 4 days. Multivariate analysis showed that major hepatectomy [OR 29.04 (2.26–37.19); P = 0.01] and resection of tumors localized in central segments [OR 41.24 (1.08–156.47); P = 0.04] were independent predictors of postoperative morbidity.

Conclusions

In experienced teams, approximately 7% of highly selected patients requiring laparoscopic hepatic surgery (wedge resection, liver cyst unroofing, or left lateral sectionectomy) could benefit from ambulatory surgery management.

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Acknowledgements

This research received no specific Grant from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, 92141, Clamart, France

    Hadrien Tranchart, Panagiotis Lainas, Martin Gaillard & Ibrahim Dagher

  2. Paris-Sud University, 91405, Orsay, France

    Hadrien Tranchart, Panagiotis Lainas, Martin Gaillard & Ibrahim Dagher

  3. Department of Digestive Diseases, Institut Mutualiste Montsouris, 75014, Paris, France

    David Fuks & Brice Gayet

  4. Paris-Descartes University, 75006, Paris, France

    David Fuks & Brice Gayet

Authors
  1. Hadrien Tranchart
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  2. David Fuks
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  4. Martin Gaillard
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  6. Brice Gayet
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Corresponding author

Correspondence to Hadrien Tranchart.

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Disclosures

Brice Gayet received royalties for “Gayet bipolar forceps” (MicroFrance BG-CEV134, Medtronic, Minneapolis, MN). Drs. Hadrien Tranchart, David Fuks, Panagiotis Lainas, Martin Gaillard, and Ibrahim Dagher have no conflicts of interest or financial ties to disclose.

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Tranchart, H., Fuks, D., Lainas, P. et al. Laparoscopic liver surgery: towards a day-case management. Surg Endosc 31, 5295–5302 (2017). https://doi.org/10.1007/s00464-017-5605-y

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  • DOI: https://doi.org/10.1007/s00464-017-5605-y

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