Laparoscopic Versus Open Approach for Formal Right and Left Hepatectomy: A Propensity Score Matching Analysis

Tozzi, Francesca; Berardi, Giammauro; Vierstraete, Maaike; Kasai, Meidai; Carvalho, Luis Abreu de; Vivarelli, Marco; Montalti, Roberto; Troisi, Roberto

doi:10.1007/s00268-018-4524-y

Cited by 29 publications

(24 citation statements)

References 46 publications

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“…MILR is frequently associated with a longer operative time (32,33). However, we did not nd any signi cant difference in operative time for patients undergoing MIRH.…”

Section: Discussioncontrasting

confidence: 72%

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Minimally invasive versus open right hepatectomy: Comparative study with propensity score matching analysis

Duarte

Coelho

Valverde

et al. 2020

Preprint

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Abstract Background Minimally invasive liver resections (MILRs) have been increasingly performed in recent years. However, the majority of MILRs are actually minor or limited resections of peripheral lesions. Due to the technical complexity major hepatectomies remain challenging for minimally invasive surgery. The aim of this study was to compare the short and long-term outcomes of patients undergoing minimally invasive right hepatectomies (MIRHs) with contemporary patients undergoing open right hepatectomies (ORHs). Methods Consecutive patients submitted to anatomic right hepatectomies between January 2013 and December 2018 in two tertiary referral centers were studied. Study groups were compared on an intention-to-treat basis after propensity score matching (PSM). Overall survival (OS) analyses were performed for the entire cohort and specific etiologies subgroups. Results During study period 178 right hepatectomies were performed. After matching, 37 patients were included in MIRH group and 60 in ORH group. The groups were homogenous for all baseline characteristics. MIRHs had significant lower blood loss (400 ml vs. 500 ml, P = 0.01), lower rate of minor complications (13.5% vs. 35%, P = 0.03) and larger resection margins (10 mm vs. 5 mm, P = 0.03) when compared to ORHs. Additionally, a non-significant decrease in hospital stay (ORH 9 days vs. MIRH 7 days, P = 0.09) was observed. No differences regarding the use of Pringle’s maneuver, operative time, major complications or perioperative mortality were observed. OS was similar between the groups (P = 0.13). Similarly, no difference in OS was found in subgroups of patients with primary liver tumors (P = 0.09) and liver metastasis (P = 0.80). Conclusions MIRHs are feasible and safe. Minimally invasive approach is associated with less blood loss, a significant reduction in minor perioperative complications, and did not negatively affect long-term outcomes.

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“…MILR is frequently associated with a longer operative time (32,33). However, we did not nd any signi cant difference in operative time for patients undergoing MIRH.…”

Section: Discussioncontrasting

confidence: 72%

“…Only recently observational studies with high methodological quality have been published comparing open and minimally invasive major resections (32,33). Takahara et al (34) using PSM showed advantages in terms of blood loss, LoS, and complications with the laparoscopic approach.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive versus open right hepatectomy: Comparative study with propensity score matching analysis

Duarte

Coelho

Valverde

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Few studies were addressed to study the results of minimally invasive major hepatectomies [ 10 , 26 , 33 ]. Only recently observational studies with high methodological quality have been published comparing open and minimally invasive major resections [ 34 , 35 ]. Takahara et al [ 36 ] using PSM showed advantages in terms of blood loss, length of hospital stay, and complications with the laparoscopic approach.…”

Section: Discussionmentioning

confidence: 99%

“…MILR is frequently associated with a longer operative time [ 34 , 35 ]. However, we did not find any significant difference in operative time for patients undergoing MIRH.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive versus open right hepatectomy: comparative study with propensity score matching analysis

et al. 2020

View full text Add to dashboard Cite

Background Minimally invasive liver resections (MILRs) have been increasingly performed in recent years. However, the majority of MILRs are actually minor or limited resections of peripheral lesions. Due to the technical complexity major hepatectomies remain challenging for minimally invasive surgery. The aim of this study was to compare the short and long-term outcomes of patients undergoing minimally invasive right hepatectomies (MIRHs) with contemporary patients undergoing open right hepatectomies (ORHs) Methods Consecutive patients submitted to anatomic right hepatectomies between January 2013 and December 2018 in two tertiary referral centers were studied. Study groups were compared on an intention-to-treat basis after propensity score matching (PSM). Overall survival (OS) analyses were performed for the entire cohort and specific etiologies subgroups Results During study period 178 right hepatectomies were performed. After matching, 37 patients were included in MIRH group and 60 in ORH group. The groups were homogenous for all baseline characteristics. MIRHs had significant lower blood loss (400 ml vs. 500 ml, P = 0.01), lower rate of minor complications (13.5% vs. 35%, P = 0.03) and larger resection margins (10 mm vs. 5 mm, P = 0.03) when compared to ORHs. Additionally, a non-significant decrease in hospital stay (ORH 9 days vs. MIRH 7 days, P = 0.09) was observed. No differences regarding the use of Pringle’s maneuver, operative time, overall morbidity or perioperative mortality were observed. OS was similar between the groups (P = 0.13). Similarly, no difference in OS was found in subgroups of patients with primary liver tumors (P = 0.09) and liver metastasis (P = 0.80). Conclusions MIRHs are feasible and safe in experienced hands. Minimally invasive approach was associated with less blood loss, a significant reduction in minor perioperative complications, and did not negatively affect long-term outcomes.

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“…Laparoscopic surgery has become a standard procedure instead of open approach for many surgical interventions and it is widely used in health services around the world. This rising interest in laparoscopy is based on several benefits, such as better surgical outcomes for patients and resource optimization for healthcare services [1]. Furthermore, this surgical technique has constantly evolved over the past few years, mainly due to training efforts of surgeons [2][3][4] and technological advances of surgical equipment [5].…”

Section: Introductionmentioning

confidence: 99%

Comparative Study of the Use of Different Sizes of an Ergonomic Instrument Handle for Laparoscopic Surgery

et al. 2020

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Previous studies have shown that the handle design of laparoscopic instruments is crucial to surgical performance and surgeon’s ergonomics. In this study, four different sizes of an ergonomic laparoscopic handle design were tested in a blind and randomized fashion with twelve surgeons. They performed three laparoscopic tasks in order to analyze the influence of handle size. Execution time, wrist posture, and finger and palm pressure were evaluated during the performance of each task. The results show a significant reduction in the time required to complete the eye-manual coordination task using the appropriate handle. The incorrectly sized handle resulted in a rise in palm pressure and a reduction in the force exerted by the thumb during the transfer task. In the hand-eye coordination task, the use of the right handle size led to an increase in middle finger pressure. In general, surgeons had an ergonomically adequate wrist flexion in all tasks and an acceptable radio-ulnar deviation during the transfer task using the ergonomic instrument handle. Surgeons found it comfortable the use of the ergonomic handle. Therefore, the use of an appropriately sized instrument handle allows surgeons to improve ergonomics and surgical performance during the laparoscopic practice.

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Laparoscopic Versus Open Approach for Formal Right and Left Hepatectomy: A Propensity Score Matching Analysis

Abstract: Laparoscopic major hepatectomies are safe and feasible procedures allowing a similar complication rate with a shorter hospital stay and diminished postoperative pain with respect to the standard approach.

Cited by 29 publications

References 46 publications

Minimally invasive versus open right hepatectomy: Comparative study with propensity score matching analysis

Minimally invasive versus open right hepatectomy: Comparative study with propensity score matching analysis

Minimally invasive versus open right hepatectomy: comparative study with propensity score matching analysis

Comparative Study of the Use of Different Sizes of an Ergonomic Instrument Handle for Laparoscopic Surgery

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