The Shift from Multiport to Single Port Increases the Amount of Bleeding in Laparoscopic Major Hepatectomy

Abstract

Background: Bleeding is a negative outcome predictor in liver surgery. Reduction in the abdominal wall trauma in major hepatectomy is challenging but might offer possible benefits for the patient. This study was conducted to assess hemostasis techniques in single-port major hepatectomies (SP-MajH) as compared to multiport major hepatectomies (MP-MajH). Methods: The non-randomized study comprised 34 SP-MajH in selected patients; 14 MP-MajH served as the control group. Intraoperative blood loss and number of blood units transfused served as the primary endpoints. Secondary endpoints were complications and oncologic five-year outcome. Results: All resections were completed without converting to open surgery. Time for hepatectomy did not differ between SP-MajH and MP-MajH. Blood loss and number of patients with blood loss > 25 mL were significantly larger in MP-MajH (p = 0.001). In contrast, bleeding control was more difficult in SP-MajH, resulting in more transfusions (p = 0.008). One intestinal laceration (SP-MajH) accounted for the only intraoperative complication; 90-day mortality was zero. Postoperative complications were noted in total in 20.6% and 21.4% of patients for SP-MajH and MP-MajH, respectively. No incisional hernia occurred. During a median oncologic follow-up at 61 and 56 months (SP-MajH and MP-MajH), no local tumor recurrence was observed. Conclusions: SP-MajH requires sophisticated techniques to ensure operative safety. Substantial blood loss requiring transfusion is more likely to occur in SP-MajH than in MP-MajH.

Single-incision laparoscopic surgery to treat hepatopancreatobiliary cancer: A technical review

“…Nearly all the case reports involved minor liver resections [partial hepatectomies, monosegmentectomies, and left lateral sectionectomies (LLS)]. Three of the eight original articles described major hepatectomies (resection of over two segments), including nine right hemihepatectomies (RHs), 34 left hemihepatectomies, and seven right posterior sectionectomies (RPSs)[ 27 , 29 , 32 ] (Table 1 ). Most procedures were performed for malignant diseases.…”

“…Hyun et al [ 26 ] reported a shorter postoperative hospital stay and comparable pathologic features for minor SILH compared with minor MILH; long-term survival outcomes were absent. Mittermair et al [ 27 ] showed less blood loss, a lower number of patients with blood loss > 25 mL, and more blood transfusions in the major SILH group; no local tumor recurrence occurred during a median follow-up of 61 mo. Tsai et al [ 28 ] reported a shorter operative time and shorter postoperative hospital stays in the SILH group for LLS but not partial hepatectomies of segment 5-6; the 1-, 3-, and 5-year overall and recurrence-free survival rates for hepatocellular carcinoma were similar in both the SILH and MILH groups.…”

“…For major hepatectomies, the two related studies came to a different conclusion. While Mittermair C et al [ 27 ] declared more substantial blood loss requiring transfusion in SILH, Han et al [ 32 ] reported a shorter operative time, less blood loss, and earlier enteral feeding for the single port technique.…”

Analogies between medusa and single port surgery in gastroenterology and hepatology: A review

“…These results were confirmed by a series from our department. Nevertheless, we observed an increased risk of substantial blood loss when bleeding occurs in these complex resections[ 40 ].…”