Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2018; 24(3): 379-386
Published online Jan 21, 2018. doi: 10.3748/wjg.v24.i3.379
Clinical advantages of single port laparoscopic hepatectomy
Jae Hyun Han, Young Kyoung You, Ho Joong Choi, Tae Ho Hong, Dong Goo Kim
Jae Hyun Han, Young Kyoung You, Ho Joong Choi, Tae Ho Hong, Dong Goo Kim, Division of Hepatobiliary-Pancreas Surgery and Liver Transplantation, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
Author contributions: Han JH collected and analyzed the data, and drafted the manuscript; You YK designed and supervised the study; Choi HJ, Hong TH and Kim DG offered the technical and statistical support; all authors have read and approved the final version to be published.
Institutional review board statement: This study was reviewed and approved by the Catholic University Seoul St. Mary’s Hospital Institutional Review Board.
Informed consent statement: Informed consent is exempted in the case of retrospective study in our institution.
Conflict-of-interest statement: There are no conflicts of interest to be disclosed.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Young Kyoung You, MD, PhD, Division of Hepatobiliary-Pancreas Surgery and Liver Transplantation, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, South Korea. yky602@catholic.ac.kr
Telephone: +82-2-22586102 Fax: +82-2-595-2992
Received: October 10, 2017
Peer-review started: October 10, 2017
First decision: October 30, 2017
Revised: November 9, 2017
Accepted: November 27, 2017
Article in press: November 27, 2017
Published online: January 21, 2018
Processing time: 102 Days and 3.5 Hours
Abstract
AIM

To evaluate the clinical advantages of single-port laparoscopic hepatectomy (SPLH) compare to multi-port laparoscopic hepatectomy (MPLH).

METHODS

We retrospectively reviewed the medical records of 246 patients who underwent laparoscopic liver resection between January 2008 and December 2015 at our hospital. We divided the surgical technique into two groups; SPLH and MPLH. We performed laparoscopic liver resection for both benign and malignant disease. Major hepatectomy such as right and left hepatectomy was also done with sufficient disease-free margin. The operative time, the volume of blood loss, transfusion rate, and the conversion rate to MPLH or open surgery was evaluated. The post-operative parameters included the meal start date after operation, the number of postoperative days spent in the hospital, and surgical complications was also evaluated.

RESULTS

Of the 246 patients, 155 patients underwent SPLH and 91 patients underwent MPLH. Conversion rate was 22.6% in SPLH and 19.8% in MPLH (P = 0.358). We performed major hepatectomy, which was defined as resection of more than 2 sections, in 13.5% of patients in the SPLH group and in 13.3% of patients in the MPLH group (P = 0.962). Mean operative time was 136.9 ± 89.2 min in the SPLH group and 231.2 ± 149.7 min in the MPLH group (P < 0.001). The amount of blood loss was 385.1 ± 409.3 mL in the SPLH group and 559.9 ± 624.9 mL in the MPLH group (P = 0.016). The safety resection margin did not show a significant difference (0.84 ± 0.84 cm in SPLH vs 1.04 ± 1.22 cm in MPLH, P = 0.704). Enteral feeding was started earlier in the SPLH group (1.06 ± 0.27 d after operation) than in the MPLH group (1.63 ± 1.27 d) (P < 0.001). The mean hospital stay after operation was non-significantly shorter in the SPLH group than in the MPLH group (7.82 ± 2.79 d vs 7.97 ± 3.69 d, P = 0.744). The complication rate was not significantly different (P = 0.397) and there was no major perioperative complication or mortality case in both groups.

CONCLUSION

Single-port laparoscopic liver surgery seems to be a feasible approach for various kinds of liver diseases.

Keywords: Hepatectomy; Laparoscopy; Minimally invasive surgery; Treatment outcome; Feasibility study

Core tip: The progress on the laparoscopic technique has led to single-port laparoscopic surgery as a feasible modality in several abdominal surgeries. However, in the field of liver surgery, single-port surgery have been reported sporadically because of its technical difficulties. In this study, we evaluated the feasibility of single-port laparoscopic hepatectomy (SPLH) compared to multi-port laparoscopic hepatectomy (MPLH). The present study showed that SPLH is not inferior to MPLH in terms of surgical and oncological results. Furthermore, left liver surgery, such as left lateral sectionectomy and left hepatectomy, is possible through single-port without any significant deterioration in results if it is performed by an experienced surgeon.