Roberto Valente1, Robert Sutcliffe2, Eric Levesque3, Mara Costa4, Nicola De' Angelis5, Claude Tayar6, Daniel Cherqui7, Alexis Laurent5. 1. Unit of Digestive Surgery, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France; Division of Surgery, University College London, Royal Free Campus, London, UK; HPB Service, Barts Health NHS Trust, London, UK. Electronic address: r.valente@ucl.ac.uk. 2. Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. 3. Service of Surgical Anesthesiology and Intensive Care, Henri Mondor Hospital, Créteil, France. 4. Unit of Digestive Surgery, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France; Division of Breast Cancer Surgery, IEO European Institute of Oncology, Milan, Italy. 5. Unit of Digestive Surgery, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France; INSERM, UMR 955, Créteil, France. 6. Department of Surgery, Clemenceau Medical Center, Beirut, Lebanon. 7. Hepato-Biliary Centre, Paul Brousse Hospital, Villejuif, France.
Abstract
BACKGROUND: Laparoscopic left hemihepatectomy (LLH) may be an alternative to open (OLH). There are several original variations in the technical aspects of LLH, and no accepted standard. The aim of this study is to assess the safety and effectiveness of the technique developed at Henri Mondor Hospital since 1996. METHODS: The technique of LLH was conceived for safety and training of two mature generations of lead surgeons. The technique includes full laparoscopy, ventral approach to the common trunk, extrahepatic pedicle dissection, CUSA® parenchymal transection, division of the left hilar plate laterally to the Arantius ligament, and ventral transection of the left hepatic vein. The outcomes of LLH and OLH were compared. Perioperative analysis included intra- and postoperative, and histology variables. Propensity Score Matching was undertaken of background covariates including age, ASA, BMI, fibrosis, steatosis, tumour size, and specimen weight. RESULTS: 17 LLH and 51 OLH were performed from 1996 to 2014 with perioperative mortality rates of 0% and 6%, respectively. In the LLH group, two patients underwent conversion to open surgery. Propensity matching selected 10 LLH/OLH pairs. The LLH group had a higher proportion of procedures for benign disease. LLH was associated with longer operating time and less blood loss. Perioperative complications occurred in 30% (LLH) and 10% (OLH) (p = 1). Mortality and ITU stay were similar. CONCLUSION: This technique is recommended as a possible technical reference for standard LLH.
BACKGROUND: Laparoscopic left hemihepatectomy (LLH) may be an alternative to open (OLH). There are several original variations in the technical aspects of LLH, and no accepted standard. The aim of this study is to assess the safety and effectiveness of the technique developed at Henri Mondor Hospital since 1996. METHODS: The technique of LLH was conceived for safety and training of two mature generations of lead surgeons. The technique includes full laparoscopy, ventral approach to the common trunk, extrahepatic pedicle dissection, CUSA® parenchymal transection, division of the left hilar plate laterally to the Arantius ligament, and ventral transection of the left hepatic vein. The outcomes of LLH and OLH were compared. Perioperative analysis included intra- and postoperative, and histology variables. Propensity Score Matching was undertaken of background covariates including age, ASA, BMI, fibrosis, steatosis, tumour size, and specimen weight. RESULTS: 17 LLH and 51 OLH were performed from 1996 to 2014 with perioperative mortality rates of 0% and 6%, respectively. In the LLH group, two patients underwent conversion to open surgery. Propensity matching selected 10 LLH/OLH pairs. The LLH group had a higher proportion of procedures for benign disease. LLH was associated with longer operating time and less blood loss. Perioperative complications occurred in 30% (LLH) and 10% (OLH) (p = 1). Mortality and ITU stay were similar. CONCLUSION: This technique is recommended as a possible technical reference for standard LLH.