Abstract
Background
Laparoscopy is considered the “gold standard” to perform left-lateral sectionectomy with results identical to those of open surgery, yielding decreased postoperative pain and disability, reduced hospital stay, and shortened patient recovery time. As the emphasis on minimizing the invasiveness of surgical techniques continues, laparoendoscopic single site (LESS) surgery is quickly evolving. The purpose of this study was to compare the results of laparoscopic left-lateral sectionectomy performed using the traditional approach or LESS approach with a case-matched analysis for tumor size, type of resection, and surgical indications.
Methods
Thirteen patients who underwent LESS left-lateral sectionectomy are considered the study group (LESS group) and compared with 13 patients who underwent left-lateral sectionectomy with traditional laparoscopic approach (conventional group).
Results
There were no significant differences between groups for length of surgery (165 min in conventional group vs. 195 min in LESS group), blood loss (150 mL in conventional group vs. 175 mL in LESS group), conversion to open surgery, histological tumor exposure, and requirements of postoperative analgesics. One patient in the LESS group died of cardiac failure due to an unknown severe aortic valve stenosis. No differences were recorded for postoperative complications (23.1% in both groups) and median length of postoperative stay (4 days in both groups).
Conclusions
For left-lateral hepatic sectionectomy, LESS surgery is technically feasible and as safe as traditional laparoscopic surgery in terms of intraoperative and postoperative results, even though requiring both hepatobiliary and laparoscopic technique experience.
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References
Koffron AJ, Auffenberg G, Kung R, Abecassis M (2007) Evaluation of 300 minimally invasive liver resections at a single institution. Less is more. Ann Surg 246:385–394
Morino M, Morra I, Rosso E, Miglietta C, Garrone C (2003) Laparoscopic vs open hepatic resection. Surg Endosc 17:1914–1918
Pulitanò C, Catena M, Arru M, Guzzetti E, Comotti L, Ferla G, Aldrighetti L (2008) Laparoscopic liver resection without portal clamping: a prospective evaluation. Surg Endosc 22:2196–2200
Ardito F, Tayar C, Laurent A, Karoui M, Loriau J, Cherqui D (2007) Laparoscopic liver resection for benign disease. Arch Surg 142(12):1188–1193
Aldrighetti L, Guzzetti E, Pulitanò C, Cipriani F, Catena M, Paganelli M, Ferla G (2010) Case-matched analysis of totally laparoscopic versus open liver resection for HCC: short and middle term results. J Surg Oncol 102:82–86
Pulitanò C, Aldrighetti L (2008) The current role of laparoscopic liver resection for the treatment of liver tumors. Nat Clin Pract Gastroenterol Hepatol 5(11):648–654
Froghi F, Sodergren MH, Darzi A, Paraskeva P (2010) Single-incision laparoscopic surgery (SILS) in general surgery. A review of current practice. Surg Laparosc Endosc Percutan Tech 20:191–204
Romanelli JR, Earle DB (2009) Single-port laparoscopic surgery: an overview. Surg Endosc 23:1419–1427
Tracy CR, Raman JD, Cadeddu JA (2008) Laparoendoscopic single-site surgery in urology: Where have we been and where are we heading? Nat Clin Pract Urol 5:561–568
Romanelli JR, Mark L, Omotosho PA (2008) Single port laparoscopic cholecystectomy with the Triport system: a case report. Surg Innov 15:223–228
Bucher P, Pugin F, Morel P (2008) Single-port access laparoscopic right hemicolectomy. Int J Colorectal Dis 23:1013–1016
Gaujoux S, Kingham P, Jarnagin WR, D’Angelica M, Allen PJ, Fong Y (2010) Single-incision laparoscopic liver resection. Surg Endosc 25:1489–1494
Aldrighetti L, Guzzetti E, Ferla G (2011) Laparoscopic hepatic left lateral sectionectomy using the LaparoEndoscopic Single Site approach: evolution of minimally invasive liver surgery. J Hepatobiliary Pancreat Sci 18:103–105
Raybourn JH, Rane A, Sundaram CP (2010) Laparoendoscopic single-site surgery for nephrectomy as a feasible alternative to traditional laparoscopy. Urology 75:100–103
Khambaty F, Brody F, Vaziri K, Edwards C (2011) Laparoscopic versus single-incision cholecystectomy. World J Surg 35:967–972
Azagra JS, Goergen M, Jacobs C, Crema E (1994) Laparoscopic left lateral segmentectomy (left hepatic lobectomy). Endosurgery 1:7–9
Chang S, Laurent A, Tayar C, Karoui M, Cherqui D (2007) Laparoscopy as a routine approach for left lateral sectionectomy. Br J Surg 94:58–63
Aldrighetti L, Pulitanò C, Catena M, Arru M, Guzzetti E, Casati M, Comotti L, Ferla G (2008) A prospective evaluation of laparoscopic versus open left lateral hepatic sectionectomy. J Gastrointest Surg 12:457–462
Azagra JS, Goergen M, Brondello S, Calmes MO, Philippe P, Schmitz B (2009) Laparoscopic liver sectionectomy 2 and 3 (LLS 2 and 3): towards the “gold standard”. J Hepatobiliary Pancreat Surg 16:422–426
Dindo D, Demarties R, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of survey. Ann Surg 240(2):205–213
Pulitanò C, Arru M, Bellio L, Rossini S, Ferla G, Aldrighetti L (2007) A risk score system for predicting perioperative blood transfusion in liver surgery. Br J Surg 94(7):860–865
Terminology Committee of the International Hepato-Pancreato-Biliary Association (2000) The IHPBA Brisbane 2000 terminology of liver anatomy and resections. HPB Surg 2:333–339
Nguyen KT, Marsh JW, Tsung A, Steel JJ, Gamblin TC, Geller DA (2011) Comparative benefits of laparoscopic vs open hepatic resection: a critical appraisal. Arch Surg 146(3):348–356
Troisi R, Van Huysse J, Berrevoet F, Vandenbossche B, Sainz-Barriga M, Vinci A, Ricciardi S, Bocchetti T, Rogiers X, de Hemptinne B (2011) Evolution of laparoscopic left lateral sectionectomy without the Pringle maneuver: through resection of benign and malignant tumors to living liver donation. Surg Endosc 25:79–87
Koh CE, Martin DJ, Cavallucci DJ, Becerril-Martinez G, Taylor CJ (2011) On the road to single-site laparoscopic adjustable gastric banding: lessons learned from 60 cases. Surg Endosc 25(3):947–953
Viganò L, Laurent A, Tayar C, Tomatis M, Ponti A, Cherqui D (2009) The learning curve in laparoscopic liver resection. Improved feasibility and reproducibility. Ann Surg 250:772–782
Disclosures
Drs. Luca Aldrighetti, Francesca Ratti, Marco Catena, Carlo Pulitanò, Fabio Ferla, Federica Cipriani, and Gianfranco Ferla have no conflicts of interest or financial ties to disclosure.
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Aldrighetti, L., Ratti, F., Catena, M. et al. Laparoendoscopic single site (LESS) surgery for left-lateral hepatic sectionectomy as an alternative to traditional laparoscopy: case-matched analysis from a single center. Surg Endosc 26, 2016–2022 (2012). https://doi.org/10.1007/s00464-012-2147-1
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DOI: https://doi.org/10.1007/s00464-012-2147-1