Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy.
School in Experimental Medicine, University of Pavia, Italy.
J Laparoendosc Adv Surg Tech A. 2021 Apr;31(4):423-432. doi: 10.1089/lap.2020.0470. Epub 2020 Aug 20.
At the end of a laparoscopic major hepatectomy, an incision wide enough for specimen retrieval is required. Classically, Pfannenstiel (PF) incision is the type of access favored as service incision in laparoscopy. However, in specific settings the use of a midline (ML) incision can be favorable, with doubtful impaction on the outcomes of a purely laparoscopic operation. The aim of this study was to investigate on clinical outcomes after laparoscopic hemihepatectomies using PF/ML incisions in comparison with open. The institutional clinical database of the Hepatobiliary Division at San Raffaele Hospital (Milan, Italy) was retrospectively reviewed identifying cases of laparoscopic and open hemihepatectomies. Three analyses were performed: whole laparoscopic versus open; ML versus open; PF versus ML. Clinical outcomes such as intraoperative blood loss, operative time, postoperative morbidity, motility resumption, perceived pain, and length of stay (LOS) were used for comparisons. Laparoscopy was confirmed to be superior to open approach also in the present series in terms of lower blood loss (300 versus 400 mL, = .041), fewer complications (14.2% versus 25.9%, = .024), shorter hospitalization (5 versus 7 days, = .033), and enhanced recovery in terms of better pain control ( = .035) and mobility resumption ( = .047). Similar outcomes were observed comparing ML alone with open (estimated blood loss 300 mL versus 400 mL, = .039; complications 13.1% versus 25.9%, = .037; LOS 5 days versus 7 days, = .04; lower pain perception, = .048 and faster mobility resumption, = .046). No significant differences were observed in postoperative outcomes of PF versus ML. Suprapubic and ML incisions at the end of a pure laparoscopic case lead to comparable outcomes between each other. The adoption of ML incision for specimen retrieval does not affect outcomes of minimal invasiveness.
在腹腔镜下进行大肝切除术时，需要足够宽的切口来取出标本。传统上，Pfannenstiel（PF）切口是腹腔镜手术中常用的入路方式。然而，在特定情况下，使用中线（ML）切口可能更为有利，对纯腹腔镜手术的结果影响不大。本研究旨在比较 PF/ML 切口与开腹手术在腹腔镜半肝切除术后的临床结果。我们回顾性分析了米兰圣拉斐尔医院肝胆科的腹腔镜和开腹半肝切除术的临床数据库。进行了三项分析：全腹腔镜与开腹；ML 与开腹；PF 与 ML。术中出血量、手术时间、术后并发症、肠蠕动恢复、疼痛感知和住院时间（LOS）等临床结果用于比较。在本系列中，腹腔镜在术中出血量（300 与 400ml，=0.041）、并发症发生率（14.2%与 25.9%，=0.024）、住院时间（5 与 7 天，=0.033）和康复方面（更好的疼痛控制，=0.035 和更快的运动恢复，=0.047）均优于开腹手术。单独使用 ML 与开腹手术的结果相似（估计出血量 300ml 与 400ml，=0.039；并发症 13.1%与 25.9%，=0.037；LOS 5 天与 7 天，=0.04；更低的疼痛感知，=0.048 和更快的运动恢复，=0.046）。PF 与 ML 之间在术后结果方面无显著差异。耻骨上和 ML 切口在纯腹腔镜手术结束时可相互产生相似的结果。采用 ML 切口取标本不会影响微创手术的效果。
