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A propensity-matched study of full laparoscopic versus hand-assisted minimal-invasive liver surgery

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Abstract

Background and aim

The implications of multi-incision (MILS) and hand-assisted (HALS) laparoscopic techniques for minimally invasive liver surgery with regard to perioperative outcomes are not well defined. The purpose of this study was to compare MILS and HALS using propensity score matching.

Methods

309 patients underwent laparoscopic liver resections (LLR) between January 2013 and June 2018. Perioperative outcomes were analyzed after a 1:1 propensity score match. Subgroup analyses of matched groups, i.e., radical lymphadenectomy (LAD) as well as resections of posterosuperior segments (VII and/or VIII), were performed.

Results

MILS was used in 187 (65.2%) and HALS in 100 (34.8%) cases, with a significant decrease of HALS resections over time (p = 0.001). There were no significant differences with regard to age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) Score, previous abdominal surgery and cirrhosis between both groups. Patients scheduled for HALS were characterized by a significantly higher rate of malignant tumors (p < 0.001) and major resections (p < 0.001). After propensity score matching (PMS), 70 cases remained in each group and all preoperative variables as well as resection extend were well balanced. A significantly higher rate of radical LAD (p = 0.039) and posterosuperior resections was found in the HALS group (p = 0.021). No significant differences between the matched groups were observed regarding operation time, conversion rate, frequency of major complications, length of intensive care unit (ICU) stay, overall hospital stay and R1 rate.

Conclusion

Our analysis suggests MILS and HALS to be equivalent regarding postoperative outcomes. HALS might be particularly helpful to accomplish complex surgical procedures during earlier stages of the learning curve.

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Author notes

  1. S. Wabitsch and W. Schöning have contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    S. Wabitsch, W. Schöning, A. Kästner, P. K. Haber, C. Benzing, F. Krenzien, M. Schmelzle & J. Pratschke

  2. Department of Biometry und Clinical Epidemiology, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, Berlin, Germany

    K. Lenz

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Contributions

SW participated in the data analysis, data interpretation, drafting the article, critical revision of the article, final approval. WS participated in the study design, data interpretation, drafting the article, critical revision of the article, final approval. AK, PKH, CB and FK participated in the data acquisition, data analysis, critical revision of the article, final approval. KL participated in the data analysis, critical revision of the article, final approval. MS and JP participated in the study design, data interpretation, critical revision of the article, final approval.

Corresponding author

Correspondence to W. Schöning.

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Disclosures

S. Wabitsch, A. Kästner, P. K. Haber, C. Benzing, F. Krenzien, and K. Lenz have no conflicts of interest or financial ties to disclose concerning the findings of this study. W. Schöning reports personal fees from Merck, personal fees from Bayer, other from Ethicon, outside the submitted work. M. Schmelzle reports personal fees from Merck, personal fees from Bayer, personal fees and other from ERBE, other from Ethicon, other from Takeda, other from Olympus, other from Medtronic, other from Intuitive, outside the submitted work. J. Pratschke reports personal fees from Verb Surgical, other from Medtronic, other from Intuitive, other from Merck, outside the submitted work.

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Wabitsch, S., Schöning, W., Kästner, A. et al. A propensity-matched study of full laparoscopic versus hand-assisted minimal-invasive liver surgery. Surg Endosc 35, 2021–2028 (2021). https://doi.org/10.1007/s00464-020-07597-2

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