Fully laparoscopic left hepatectomy - a technical reference proposed for standard practice compared to the open approach: a retrospective propensity score model.

Valente, Roberto and Sutcliffe, Robert and Levesque, Eric and Costa, Mara and De' Angelis, Nicola and Tayar, Claude and Cherqui, Daniel and Laurent, Alexis (2018) Fully laparoscopic left hepatectomy - a technical reference proposed for standard practice compared to the open approach: a retrospective propensity score model. HPB : the official journal of the International Hepato Pancreato Biliary Association, 20 (4). pp. 347-355. ISSN 1477-2574.

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Official URL: https://www.hpbonline.org/article/S1365-182X(17)31...

Abstract

BACKGROUND

Laparoscopic left hemihepatectomy (LLH) may be an alternative to open (OLH). There are several original variations in the technical aspects of LLH, and no accepted standard. The aim of this study is to assess the safety and effectiveness of the technique developed at Henri Mondor Hospital since 1996.

METHODS

The technique of LLH was conceived for safety and training of two mature generations of lead surgeons. The technique includes full laparoscopy, ventral approach to the common trunk, extrahepatic pedicle dissection, CUSA parenchymal transection, division of the left hilar plate laterally to the Arantius ligament, and ventral transection of the left hepatic vein. The outcomes of LLH and OLH were compared. Perioperative analysis included intra- and postoperative, and histology variables. Propensity Score Matching was undertaken of background covariates including age, ASA, BMI, fibrosis, steatosis, tumour size, and specimen weight.

RESULTS

17 LLH and 51 OLH were performed from 1996 to 2014 with perioperative mortality rates of 0% and 6%, respectively. In the LLH group, two patients underwent conversion to open surgery. Propensity matching selected 10 LLH/OLH pairs. The LLH group had a higher proportion of procedures for benign disease. LLH was associated with longer operating time and less blood loss. Perioperative complications occurred in 30% (LLH) and 10% (OLH) (p = 1). Mortality and ITU stay were similar.

CONCLUSION

This technique is recommended as a possible technical reference for standard LLH.

Item Type: Article
Subjects: WO Surgery
Divisions: Emergency Services
Related URLs:
Depositing User: Jennifer Manders
Date Deposited: 31 May 2019 15:26
Last Modified: 31 May 2019 15:26
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/2132

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