Published online Jan 21, 2018. doi: 10.3748/wjg.v24.i3.379
Peer-review started: October 10, 2017
First decision: October 30, 2017
Revised: November 9, 2017
Accepted: November 27, 2017
Article in press: November 27, 2017
Published online: January 21, 2018
Processing time: 102 Days and 3.5 Hours
The progress on the laparoscopic technique and instruments has led to single-port laparoscopic surgery as a safe and feasible modality. However, in the field of liver surgery, technical difficulty has delayed its widespread adoption. Recently, several investigators have reported feasible results of single-port laparoscopic hepatectomy (SPLH) however, almost of them are case reports or small sized study.
Several studies have assessed the feasibility of SPLH in benign diseases such as left lateral sectionectomy and partial hepatectomy in spite of intrinsic technical limitations. However, most of them are for benign diseases and the study size is too small to determine the feasibility.
The aim of the present study is to investigate the technical feasibility and perioperative results of SPLH compared to the conventional laparoscopic surgery in a large volume center.
Total enrolled patients were 246 and the data was collected from January 2008 to December 2015. The authors divided the surgical technique into two groups; SPLH and multi-port laparoscopic hepatectomy (MPLH). The authors performed laparoscopic liver resection for both benign and malignant disease. Major hepatectomy was done in the case that the disease free margin will be achieved without problems. The operative time, the volume of blood loss, transfusion rate, and the conversion rate to MPLH or open surgery was evaluated. The post-operative parameters included the meal start date after operation, the number of postoperative days spent in the hospital, and surgical complications was also evaluated.
In this study, the authors found that the operative results such as the operative time, the volume of blood loss, transfusion rate, and the conversion rate of the SPLH was not inferior to the MPLH. The post-operative parameters such as the meal start date after operation was even better than MPLH. It showed similar results in the analysis of the left liver surgery such as left hepatectomy and left lateral sectionectomy.
The present study showed that SPLH is not inferior to MPLH in terms of surgical and oncological results after favorable patient selection. Furthermore, left liver lobe surgery, such as left lateral sectionectomy and left hepatectomy, is possible through single-port laparoscopic surgery without any significant deterioration in results compared to MPLH if it is performed by an experienced surgeon.
In the future work, case controlled and/or large size prospective study will be needed.