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. 2022 Jun;36(6):4470-4478.
doi: 10.1007/s00464-021-08800-8. Epub 2021 Oct 25.

Pure laparoscopic vs. hand-assisted liver surgery for segments 7 and 8: propensity score matching analysis

Víctor Lopez-Lopez  1 , Asunción López-Conesa  1 , Roberto Brusadin  1 , Domingo Perez-Flores  2 , Álvaro Navarro-Barrios  1 , Paula Gomez-Valles  1 , Valentín Cayuela  1 , Ricardo Robles-Campos  3
Affiliations

Pure laparoscopic vs. hand-assisted liver surgery for segments 7 and 8: propensity score matching analysis

Víctor Lopez-Lopez et al. Surg Endosc. 2022 Jun.

Abstract

Background: Laparoscopic liver resection of tumors located in segments 7 and 8 are considered a complex resection. The aim of this study was to compare the intraoperative and early postoperative outcomes of patients operated by pure laparoscopic (PLS) vs hand-assisted laparoscopic surgery (HALS).

Methods: From January 2003 to January 2021, we included patients with minimally invasive surgery for lesions located in segments 7 and 8. To overcome selection bias, we performed 1:1 propensity score matching (PSM) between HALS and PLS cohorts, including 30 patients in each of the groups. Of the 60 patients who underwent PSM, we compared the first 30 patients with the following 30 patients.

Results: A total of 79 LLRs were performed, 46 by HALS and 33 by PLS. After PSM, in the PLS cohort, cirrhosis was more frequent (33.3% vs. 13.3%, p = 0.02). The surgical time, blood loss, Pringle maneuver, clamping time, and morbidity were similar between both groups, but with a lower hospital stay in the PLS group (3 days vs. 4 days, p < 0.01). In the first 30 patients who underwent LLR, the use of PLS was lower than the use of HALS, increasing due to the learning curve (16.7% in the first period vs. 83.3% in the second period; p < 0.01). The hospital stay was lower in the second period due to the more frequent use of PLS (3 vs. 4 days, p < 0.01).

Conclusion: PLS presents similar intraoperative and early postoperative results with lower hospital stay for lesions located in segments 7 and 8 compared to HALS. In centers with experience in LLRs, PLS could be performed safely in these segments.

Keywords: Hand assited laparoscopic surgery; Liver resection; Perioperative outcomes; Postero-superior liver segments; Pure laparoscopic surgery.

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