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Surgical Endoscopy
Published in: Surgical Endoscopy 11/2018

01-11-2018 | 2018 SAGES Oral

Changing trends and outcomes associated with the adoption of minimally invasive hepatectomy: a contemporary single-institution experience with 400 consecutive resections

Authors: Brian K. P. Goh, Ser-Yee Lee, Jin-Yao Teo, Juinn-Huar Kam, Prema-Raj Jeyaraj, Peng-Chung Cheow, Pierce K. H. Chow, London L. P. J. Ooi, Alexander Y. F. Chung, Chung-Yip Chan

Published in: Surgical Endoscopy | Issue 11/2018

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Abstract

Background

Several studies published mainly from pioneers and early adopters have documented the evolution of minimally invasive hepatectomy (MIH). However, questions remain if these reported experiences are applicable and reproducible today. This study examines the changing trends, safety, and outcomes associated with the adoption of MIH based on a contemporary single-institution experience.

Methods

This is a retrospective review of 400 consecutive patients who underwent MIH between 2006 and 2017 of which 360 cases (90%) were performed since 2012. To determine the evolution of MIH, the study population was stratified into four equal groups of 100 patients. Analyses were also performed of predictive factors and outcomes of open conversion.

Results

Four hundred patients underwent MIH of which 379 (94.8%) were totally laparoscopic/robotic. Eighty-eight (22.0%) patients underwent major hepatectomy and 160 (40.0%) had resection of tumors located in the posterosuperior segments. There were 38 (9.5%) open conversions. Comparison across the four groups demonstrated that patients were older, had higher ASA score, and had increased frequency of previous abdominal surgery and repeat liver resections. There was also an increase in the proportion of patients who underwent totally laparoscopic/robotic surgery, major liver resection, resection of ≥ 3 segments, and multiple resections. Comparison of outcomes demonstrated that there was a significant decrease in open conversion rate, longer operation time, and increased use of Pringles maneuver. The presence of cirrhosis and institution experience (1st 100 cases) were independent predictors of open conversion. Patients who required open conversion had significantly increased operation time, blood loss, blood transfusion rate, morbidity, and mortality.

Conclusion

The case volume of MIH performed increased rapidly at our institution over time. Although the indications of MIH expanded to include higher risk patients and more complex hepatectomies, there was a decrease in open conversion rate and no change in other perioperative outcomes.
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Metadata
Title
Changing trends and outcomes associated with the adoption of minimally invasive hepatectomy: a contemporary single-institution experience with 400 consecutive resections
Authors
Brian K. P. Goh
Ser-Yee Lee
Jin-Yao Teo
Juinn-Huar Kam
Prema-Raj Jeyaraj
Peng-Chung Cheow
Pierce K. H. Chow
London L. P. J. Ooi
Alexander Y. F. Chung
Chung-Yip Chan
Publication date
01-11-2018
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 11/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-6310-1

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