How does laparoscopic-assisted hepatic resection compare with the conventional open surgical approach?

Lynt B. Johnson, Jay A. Graham, David A. Weiner, John Smirniotopoulos

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Laparoscopic-assisted hepatic resection (LAHR) has been described as a safe and reliable means of liver resection for tumors or live-donor hepatectomy. Here we compare the outcomes in paired cohorts between patients undergoing open hepatic resection (OHR) and LAHR. Study Design: Two hundred and twelve patients who underwent either OHR or LAHR from March 2004 to July 2011 were analyzed to assess outcomes. During this time period, 124 patients underwent OHR and 88 underwent LAHR. Demographic and outcomes data were assessed. Results: In the total patient cohort, mean age found in both surgical arms was similar, as was the mean BMI. In addition, there was no difference in the cohort between those who underwent either minor or major hepatic resections (p = 0.52). Operatively, in the OHR arm the mean duration of the operation was 234 minutes and comparable with LAHR at 238 minutes (p = 0.75). There was also no difference in the mean lesion size in the OHR (5.72 cm) and LAHR (5.37 cm) groups (p = 0.55). Notably, there was no difference in the complication incidence rates, which were 10.5% (OHR) and 6.8% (LAHR) (p = 0.59). However, when analyzing for length of stay, there was a significant difference between the 2 arms; patients in OHR arm had longer stays than those in the LAHR arm (7.59 days vs 6.30 days, respectively; mean difference 1.29 days; 95% CI, 0.08-2.5; p = 0.036). Conclusions: Although reduced surgical pain, improved cosmesis, and shortened hospital stays have been shown to correlate with laparoscopic abdominal procedures, our study indicates these marked advantages are also conferred to those undergoing LAHR. In addition, these findings demonstrate the use of LAHR and highlight the need for the addition of this technique to the liver surgeon's skill set.

Original languageEnglish (US)
Pages (from-to)717-723
Number of pages7
JournalJournal of the American College of Surgeons
Volume214
Issue number4
DOIs
StatePublished - Apr 2012
Externally publishedYes

Fingerprint

Liver
Length of Stay
Hepatectomy
Demography
Tissue Donors
Pain

Keywords

  • BMI
  • body mass index
  • EBL
  • estimated blood loss
  • LAHR
  • laparoscopic-assisted hepatic resection
  • length of stay
  • LOS
  • OHR
  • open hepatic resection

ASJC Scopus subject areas

  • Surgery

Cite this

How does laparoscopic-assisted hepatic resection compare with the conventional open surgical approach? / Johnson, Lynt B.; Graham, Jay A.; Weiner, David A.; Smirniotopoulos, John.

In: Journal of the American College of Surgeons, Vol. 214, No. 4, 04.2012, p. 717-723.

Research output: Contribution to journalArticle

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title = "How does laparoscopic-assisted hepatic resection compare with the conventional open surgical approach?",
abstract = "Background: Laparoscopic-assisted hepatic resection (LAHR) has been described as a safe and reliable means of liver resection for tumors or live-donor hepatectomy. Here we compare the outcomes in paired cohorts between patients undergoing open hepatic resection (OHR) and LAHR. Study Design: Two hundred and twelve patients who underwent either OHR or LAHR from March 2004 to July 2011 were analyzed to assess outcomes. During this time period, 124 patients underwent OHR and 88 underwent LAHR. Demographic and outcomes data were assessed. Results: In the total patient cohort, mean age found in both surgical arms was similar, as was the mean BMI. In addition, there was no difference in the cohort between those who underwent either minor or major hepatic resections (p = 0.52). Operatively, in the OHR arm the mean duration of the operation was 234 minutes and comparable with LAHR at 238 minutes (p = 0.75). There was also no difference in the mean lesion size in the OHR (5.72 cm) and LAHR (5.37 cm) groups (p = 0.55). Notably, there was no difference in the complication incidence rates, which were 10.5{\%} (OHR) and 6.8{\%} (LAHR) (p = 0.59). However, when analyzing for length of stay, there was a significant difference between the 2 arms; patients in OHR arm had longer stays than those in the LAHR arm (7.59 days vs 6.30 days, respectively; mean difference 1.29 days; 95{\%} CI, 0.08-2.5; p = 0.036). Conclusions: Although reduced surgical pain, improved cosmesis, and shortened hospital stays have been shown to correlate with laparoscopic abdominal procedures, our study indicates these marked advantages are also conferred to those undergoing LAHR. In addition, these findings demonstrate the use of LAHR and highlight the need for the addition of this technique to the liver surgeon's skill set.",
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