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06-03-2022 | Abdominal Surgery | Original Article

Risk factors of unplanned intraoperative conversion to hand-assisted laparoscopic surgery or open surgery in laparoscopic liver resection

Authors: Takashi Masuda, Yuichi Endo, Shota Amano, Masahiro Kawamura, Atsuro Fujinaga, Hiroaki Nakanuma, Takahide Kawasaki, Yoko Kawano, Teijiro Hirashita, Yukio Iwashita, Masayuki Ohta, Masafumi Inomata

Published in: Langenbeck's Archives of Surgery | Issue 5/2022

Abstract

Background

Laparoscopic liver resection (LLR) is possible in many patients, but pure LLR is sometimes difficult to complete, and unplanned intraoperative hand-assisted laparoscopic surgery (HALS) or open conversion is sometimes necessary. However, appropriate indications and timing for conversion are unclear. This study aimed to clarify the indications for HALS and open conversion from pure LLR.

Methods

We collected data from 208 patients who underwent LLR from January 2010 to February 2021 in our department. We retrospectively examined these data between cases of unplanned intraoperative HALS conversion, open conversion, and pure LLR, and clarified risk factors and indications for HALS or open conversion.

Results

There were 191 pure LLRs, nine HALS conversions, and eight open conversions. In the HALS conversion group versus pure LLR group, body mass index (BMI) (27.0 vs. 23.7 kg/m², p = 0.047), proportions of patients with history of upper abdominal surgery (78% vs. 33%; p = 0.006), repeat hepatectomy (56% vs. 15%; p = 0.002), S7 or S8 tumor location (67% vs. 35%; p = 0.049), and difficulty score (DS) ≥ 7 (56% vs. 19%; p = 0.008) were significantly higher, and surgical time (339 vs. 239 min; p = 0.031) was significantly longer. However, postoperative states were not significantly different between the two groups. The BMI cutoff value for risk of unplanned intraoperative conversion determined by receiver operating characteristic curve analysis was 25 kg/m², and the proportion of patients with BMI ≥ 25 kg/m² (89% vs. 31%, p < 0.001) was significantly higher in the HALS conversion versus pure LLR group. In the open conversion group, although there were no significant differences compared to the HALS group in clinicopathological factors except for sex, blood loss was greater (1425 vs. 367 mL; p < 0.001).

Conclusion

Risk factors for considering HALS during LLR were patients with a history of upper abdominal surgery including repeat hepatectomy, BMI ≥ 25 kg/m², S7 or S8 tumor location, DS ≥ 7, and prolonged surgical time. Furthermore, uncontrollable intraoperative bleeding was an indication for open conversion.

Reich H, McGlynn F, DeCaprio J, Budin R (1991) Laparoscopic excision of benign liver lesions. Obstet Gynecol 78:956–958PubMed

Buell JF, Thomas MT, Rudich S, Marvin M, Nagubandi R, Ravindra KV, Brock G, McMasters KM (2008) Experience with more than 500 minimally invasive hepatic procedures. Ann Surg 248:475–486CrossRef

Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection-2,804 patients. Ann Surg 250:831–841CrossRef

Takahashi Y, Katagiri S, Ariizumi SI, Kotera Y, Egawa H, Wakabayashi G, Kaneko H, Yamamoto M (2017) Laparoscopic hepatectomy: current state in Japan based on the 4th Nationwide Questionnaire. Gastroenterol Res Pract 2017:6868745CrossRef

Hasegawa Y, Koffron AJ, Buell JF, Wakabayashi G (2015) Approaches to laparoscopic liver resection: a meta-analysis of the role of hand-assisted laparoscopic surgery and the hybrid technique. J Hepatobiliary Pancreat Sci 22:335–341CrossRef

Cuschieri A (2000) Laparoscopic hand-assisted surgery for hepatic and pancreatic disease. Surg Endosc 14:991–996CrossRef

Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, Hasegawa Y, Katagiri T, Takagi C, Itano O, Kaneko H, Wakabayashi G (2014) A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci 21:745–753CrossRef

Wakabayashi G (2016) What has changed after the Morioka consensus conference 2014 on laparoscopic liver resection? Hepatobiliary Surg Nutr 5:281–289CrossRef

Strasberg SM, Belghiti J, Clavien PA, Gadzijev E, Garden JO, Lau WY, Makuuchi M, Strong RW (2000) The Brisbane 2000 Terminology of Liver Anatomy and Resections. HPB (Oxford) 2:333–339CrossRef

10.

Hasegawa Y, Wakabayashi G, Nitta H, Takahara T, Katagiri H, Umemura A, Makabe K, Sasaki A (2017) A novel model for prediction of pure laparoscopic liver resection surgical difficulty. Surg Endosc 31:5356–5363CrossRef

11.

Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R (1973) Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60:646–649CrossRef

12.

Ichida F, Tsuji T, Omata M, Ichida T, Inoue K, Kamimura T, Yamada G, Hino K, Yokosuka O, Suzuki H (1996) New Inuyama classification; new criteria for histological assessment of chronic hepatitis. Int Hepatol Commun 6:112–119CrossRef

13.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef

14.

Dagher I, O’Rourke N, Geller DA, Cherqui D, Belli G, Gamblin TC, Lainas P, Laurent A, Nguyen KT, Marvin MR, Thomas M, Ravindra K, Fielding G, Franco D, Buell JF (2009) Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg 250:856–860CrossRef

15.

Lin S, Wu F, Wang L, Liu Y, Zheng Y, Siqin T, Rong W, Wu J (2019) Surgical outcomes of hand-assisted laparoscopic liver resection vs. open liver resection: a retrospective propensity score-matched cohort study. Chin J Cancer Res 31:818–824CrossRef

16.

Kanazawa M, Yoshiike N, Osaka T, Numba Y, Zimmet P, Inoue S (2005) Criteria and classification of obesity in Japan and Asia-Oceania. World Rev Nutr Diet 94:1–12PubMed

17.

Cauchy F, Fuks D, Nomi T, Schwarz L, Barbier L, Dokmak S, Scatton O, Belghiti J, Soubrane O, Gayet B (2015) Risk factors and consequences of conversion in laparoscopic major liver resection. Br J Surg 102:785–795CrossRef

18.

Halls MC, Cipriani F, Berardi G, Barkhatov L, Lainas P, Alzoubi M, D’Hondt M, Rotellar F, Dagher I, Aldrighetti L, Troisi RI, Edwin B, Abu Hilal M (2018) Conversion for unfavorable intraoperative events results in significantly worse outcomes during laparoscopic liver resection: lessons learned from a multicenter review of 2861 cases. Ann Surg 268:1051–1057CrossRef

19.

Kobayashi Y, Shindoh J, Igata Y, Okubo S, Hashimoto M (2020) A novel scoring system for evaluating the difficulty of lysis of adhesion and surgical risk at repeat hepatectomy. J Hepatobiliary Pancreat Sci 27:191–199CrossRef

20.

Onoe T, Yamaguchi M, Irei T, Ishiyama K, Sudo T, Hadano N, Kojima M, Kubota H, Ide R, Tazawa H, Shimizu W, Suzuki T, Shimizu Y, Hinoi T, Tashiro H (2019) Feasibility and efficacy of repeat laparoscopic liver resection for recurrent hepatocellular carcinoma. Surg Endosc 34:4574–4581CrossRef

21.

Wakabayashi T, Felli E, Memeo R, Mascagni P, Abe Y, Kitagawa Y, Pessaux P (2019) Short-term outcomes of laparoscopic repeat liver resection after open liver resection: a systematic review. Surg Endosc 33:2083–2092CrossRef

22.

Ome Y, Hashida K, Yokota M, Nagahisa Y, Yamaguchi K, Okabe M, Kawamoto K (2018) The feasibility and efficacy of pure laparoscopic repeat hepatectomy. Surg Endosc 32:3474–3479CrossRef

23.

Sigel B, Golub RM, Loiacono LA, Parsons RE, Kodama I, Machi J, Justin J, Sachdeva AK, Zaren HA (1991) Technique of ultrasonic detection and mapping of abdominal wall adhesions. Surg Endosc 5:161–165CrossRef

24.

Uchida H, Iwashita Y, Saga K, Takayama H, Watanabe K, Endo Y, Yada K, Ohta M, Inomata M (2016) Clinical utility of the Difficulty Scoring System for predicting surgical time of laparoscopic liver resection. J Laparoendosc Adv Surg Tech A 26:702–706CrossRef

25.

Uchida H, Iwashita Y, Tada K, Saga K, Takayama H, Hirashita T, Endo Y, Ohta M, Inomata M (2018) Laparoscopic liver resection in cirrhotic patients with specific reference to a difficulty scoring system. Langenbecks Arch Surg 403:371–377CrossRef

26.

Vaccaro CA, Rossi GL, Quintana GO, Soriano ER, Vaccarezza H, Rubinstein F (2014) Laparoscopic colorectal resections: a simple predictor model and a stratification risk for conversion to open surgery. Dis Colon Rectum 57:869–874CrossRef

27.

Iwashita Y, Uchida H, Takayama H, Ichimanda M, Taniguchi K, Kiguchi H, Sakaguchi T, Fujishima H, Saga K, Tada K, Hara T, Watanabe K, Hirashita T, Endo Y, Ohta M, Inomata M (2018) Control of inferior vena cava injury during laparoscopic surgery using a double balloon-equipped central venous catheter: proof of concept in a live porcine model. Surg Endosc 32:2397–2401CrossRef

Title: Risk factors of unplanned intraoperative conversion to hand-assisted laparoscopic surgery or open surgery in laparoscopic liver resection
Authors: Takashi Masuda
Yuichi Endo
Shota Amano
Masahiro Kawamura
Atsuro Fujinaga
Hiroaki Nakanuma
Takahide Kawasaki
Yoko Kawano
Teijiro Hirashita
Yukio Iwashita
Masayuki Ohta
Masafumi Inomata
Publication date: 06-03-2022
Publisher: Springer Berlin Heidelberg
Keywords: Abdominal Surgery
Liver Resection
Liver Resection
Published in: Langenbeck's Archives of Surgery / Issue 5/2022
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-022-02466-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors of unplanned intraoperative conversion to hand-assisted laparoscopic surgery or open surgery in laparoscopic liver resection

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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