Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain.
Department of Biostatistics, Murcia Universtiy, Murcia, Spain.
Surg Endosc. 2022 Jun;36(6):4470-4478. doi: 10.1007/s00464-021-08800-8. Epub 2021 Oct 25.
Laparoscopic liver resection of tumors located in segments 7 and 8 are considered a complex resection. The aim of this study was to compare the intraoperative and early postoperative outcomes of patients operated by pure laparoscopic (PLS) vs hand-assisted laparoscopic surgery (HALS).
From January 2003 to January 2021, we included patients with minimally invasive surgery for lesions located in segments 7 and 8. To overcome selection bias, we performed 1:1 propensity score matching (PSM) between HALS and PLS cohorts, including 30 patients in each of the groups. Of the 60 patients who underwent PSM, we compared the first 30 patients with the following 30 patients.
A total of 79 LLRs were performed, 46 by HALS and 33 by PLS. After PSM, in the PLS cohort, cirrhosis was more frequent (33.3% vs. 13.3%, p = 0.02). The surgical time, blood loss, Pringle maneuver, clamping time, and morbidity were similar between both groups, but with a lower hospital stay in the PLS group (3 days vs. 4 days, p < 0.01). In the first 30 patients who underwent LLR, the use of PLS was lower than the use of HALS, increasing due to the learning curve (16.7% in the first period vs. 83.3% in the second period; p < 0.01). The hospital stay was lower in the second period due to the more frequent use of PLS (3 vs. 4 days, p < 0.01).
PLS presents similar intraoperative and early postoperative results with lower hospital stay for lesions located in segments 7 and 8 compared to HALS. In centers with experience in LLRs, PLS could be performed safely in these segments.
位于 7 段和 8 段的肿瘤的腹腔镜肝切除术被认为是一种复杂的切除术。本研究旨在比较单纯腹腔镜（PLS）与手助腹腔镜手术（HALS）治疗 7 段和 8 段病变患者的术中及早期术后结果。
自 2003 年 1 月至 2021 年 1 月，我们纳入了接受微创治疗位于 7 段和 8 段的病变的患者。为了克服选择偏倚，我们对 HALS 和 PLS 两组患者进行了 1:1 倾向评分匹配（PSM），每组各 30 例。在 60 例接受 PSM 的患者中，我们比较了前 30 例和后 30 例患者。
共进行了 79 例腹腔镜肝切除术，其中 46 例采用 HALS，33 例采用 PLS。PSM 后，PLS 组肝硬化更为常见（33.3%比 13.3%，p=0.02）。两组手术时间、出血量、Pringle 操作、阻断时间和并发症发生率相似，但 PLS 组住院时间较短（3 天比 4 天，p<0.01）。在接受腹腔镜肝切除术的前 30 例患者中，PLS 的使用率低于 HALS，随着学习曲线的发展而增加（第一阶段为 16.7%，第二阶段为 83.3%；p<0.01）。由于 PLS 更频繁的使用，第二阶段的住院时间较低（3 天比 4 天，p<0.01）。
与 HALS 相比，PLS 治疗 7 段和 8 段病变具有相似的术中及早期术后结果，且住院时间较短。在具有腹腔镜肝切除术经验的中心，PLS 可安全用于这些部位。
