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01-05-2021 | Liver Surgery

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

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

Published in: Surgical Endoscopy | Issue 5/2021

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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Title: A propensity-matched study of full laparoscopic versus hand-assisted minimal-invasive liver surgery
Authors: S. Wabitsch
W. Schöning
A. Kästner
P. K. Haber
C. Benzing
F. Krenzien
K. Lenz
M. Schmelzle
J. Pratschke
Publication date: 01-05-2021
Publisher: Springer US
Keywords: Liver Surgery
Liver Resection
Liver Surgery
Liver Resection
Incision
Lymphadenectomy
Published in: Surgical Endoscopy / Issue 5/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07597-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background and aim

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and aim

Methods

Results

Conclusion

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