Iqbal Affan, Baltatzis Minas, Stathakis Panagiotis, Barrie Jenifer, Siriwardena Ajith Kumar, Jamdar Saurabh, Sheen Aali Jan
Dept of Hepatopancreatobiliary (HPB), Manchester Foundation National Health Service (NHS) Trust, Manchester, United Kingdom.
Dept of General Surgery, Northern Care Alliance Foundation National Health Service (NHS) Trust, Manchester, United Kingdom.
Front Oncol. 2025 Jul 23;15:1616876. doi: 10.3389/fonc.2025.1616876. eCollection 2025.
In 2019, preliminary data matching 20 laparoscopic (using LOTUS) with 20 open (using CUSA) cases demonstrated the feasibility and improved outcomes of laparoscopic major liver resections using the LOTUS™ liver blade. This updated study presents a larger comparison between open and laparoscopic major hepatectomies and, for the first time, evaluates the safety of the endovascular stapler AEON™ (Lexington Medical, Massachusetts, USA).
All consecutive patients who underwent liver resections, both open and laparoscopic, from January 2020 to June 2023 were identified from a prospectively maintained database. Propensity score matching was performed to identify matched open and laparoscopic cases, which were compared for intra- and post-operative short-term outcomes. The LOTUS™ ultrasonic energy device was used for transection in laparoscopic cases, whereas CUSA was used in open procedures. AEON was introduced in 2021 and compared with the previously used stapler.
The initial sample of 116 patients was narrowed to 86 after applying 1:1 matching. The median age was 63 years (range 27-83). Laparoscopic cases showed reduced hospital stay (mean 7.8 vs. 14.7 days; p = 0.025), increased Pringle time (48.5 vs. 33 minutes; p = 0.010), and reduced transfusion requirements (0 vs. 4 units; p = 0.035). Comparing AEON™ with Endo-GIA showed no statistical differences, though AEON™ showed a possible trend toward reduced transection time overall (56 vs. 69 minutes; p = 0.300) and in laparoscopic cases (56 vs. 71 minutes; p = 0.295).
The LOTUS™ liver blade continues to demonstrate safety and efficacy in laparoscopic liver resections. Transection time has improved compared to the earlier study, likely reflecting increased experience. AEON™ is shown to be non-inferior for vessel ligation, with a potential trend toward reduced transection time in both open and laparoscopic cases.
2019年，对20例腹腔镜手术（使用LOTUS）和20例开放手术（使用CUSA）病例的初步数据匹配显示，使用LOTUS™肝叶切割器进行腹腔镜大肝切除术具有可行性且效果更佳。这项更新后的研究对开放和腹腔镜大肝切除术进行了更大规模的比较，并首次评估了血管吻合器AEON™（美国马萨诸塞州列克星敦医疗公司）的安全性。
从一个前瞻性维护的数据库中识别出2020年1月至2023年6月期间接受肝切除术的所有连续患者，包括开放手术和腹腔镜手术患者。进行倾向评分匹配以识别匹配的开放和腹腔镜病例，并比较其术中和术后短期结局。腹腔镜病例中使用LOTUS™超声能量装置进行肝实质离断，而开放手术中使用CUSA。AEON于2021年引入并与之前使用的吻合器进行比较。
应用1:1匹配后，最初的116例患者样本缩小至86例。中位年龄为63岁（范围27 - 83岁）。腹腔镜病例的住院时间缩短（平均7.8天对14.7天；p = 0.025），肝门阻断时间延长（48.5分钟对33分钟；p = 0.010），输血需求减少（0单位对4单位；p = 0.035）。将AEON™与Endo - GIA进行比较，未显示出统计学差异，尽管AEON™总体上显示出肝实质离断时间可能有缩短趋势（56分钟对69分钟；p = 0.300），在腹腔镜病例中也是如此（56分钟对71分钟；p = 0.295）。
LOTUS™肝叶切割器在腹腔镜肝切除术中继续展现出安全性和有效性。与早期研究相比，肝实质离断时间有所改善，这可能反映了经验的增加。AEON™在血管结扎方面显示出非劣效性，在开放和腹腔镜病例中均有肝实质离断时间缩短的潜在趋势。
