A Literature Review to Assess Blood Loss in Minimally Invasive Liver Surgery Versus in Open Liver Resection

Abstract Purpose Minimally invasive liver surgery (MILS) is a feasible and safe procedure for benign and malignant tumors. There has been an ongoing debate on whether conventional laparoscopic liver resection (LLR) or robotic liver resection (RLR) is superior and if one approach should be favored over the other. We started using LLR in 2010, and introduced RLR in 2013. In the present paper, we report on our experiences with these two techniques as early adopters in Germany. Methods The data of patients who underwent MILS between 2010 and 2020 were collected prospectively in the Magdeburg Registry for Minimally Invasive Liver Surgery (MD-MILS). A retrospective analysis was performed regarding patient demographics, tumor characteristics, and perioperative parameters. Results We identified 155 patients fulfilling the inclusion criteria. Of these, 111 (71.6%) underwent LLR and 44 (29.4%) received RLR. After excluding cystic lesions, 113 cases were used for the analysis of perioperative parameters. Resected specimens were significantly bigger in the RLR vs. the LLR group (405 g vs. 169 g, p = 0.002); in addition, the tumor diameter was significantly larger in the RLR vs. the LLR group (5.6 cm vs. 3.7 cm, p = 0.001). Hence, the amount of major liver resections (three or more segments) was significantly higher in the RLR vs. the LLR group (39.0% vs. 16.7%, p = 0.005). The mean operative time was significantly longer in the RLR vs. the LLR group (331 min vs. 181 min, p = 0.0001). The postoperative hospital stay was significantly longer in the RLR vs. the LLR group (13.4 vs. LLR 8.7 days, p = 0.03). The R0 resection rate for solid tumors was higher in the RLR vs. the LLR group but without statistical significance (93.8% vs. 87.9%, p = 0.48). The postoperative morbidity ≥ Clavien-Dindo grade 3 was 5.6% in the LLR vs. 17.1% in the RLR group (p = 0.1). No patient died in the RLR but two patients (2.8%) died in the LLR group, 30 and 90 days after surgery (p = 0.53). Conclusion Minimally invasive liver surgery is safe and feasible. Robotic and laparoscopic liver surgery shows similar and adequate perioperative oncological results for selected patients. RLR might be advantageous for more advanced and technically challenging procedures.

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Laparoscopic liver resection of hepatocellular carcinoma located in unfavorable segments: a propensity score-matched analysis from the I Go MILS (Italian Group of Minimally Invasive Liver Surgery) Registry

Surgical Endoscopy ◽

10.1007/s00464-018-6426-3 ◽

2018 ◽

Vol 33 (5) ◽

pp. 1451-1458 ◽

Cited By ~ 12

Author(s):

Giovanni Battista Levi Sandri ◽

◽

Giuseppe Maria Ettorre ◽

Luca Aldrighetti ◽

Umberto Cillo ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Propensity Score ◽

Minimally Invasive ◽

Liver Surgery ◽

Laparoscopic Liver Resection ◽

Minimally Invasive Liver Surgery

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Laparoscopic liver resection of hepatocellular carcinoma located in unfavaroble segments: a propensity score-matched analysis from the Italian group of minimally invasive liver surgery registry

HPB ◽

10.1016/j.hpb.2018.06.222 ◽

2018 ◽

Vol 20 ◽

pp. S268

Author(s):

G.B. Levi Sandri ◽

L. Aldrighetti ◽

U. Cillo ◽

R. Dalla Valle ◽

A. Guglielmi ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Propensity Score ◽

Minimally Invasive ◽

Liver Surgery ◽

Laparoscopic Liver Resection ◽

Minimally Invasive Liver Surgery

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Total laparoscopic vs. open liver resection: comparative study with propensity score matching analysis

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020190001e1494 ◽

2020 ◽

Vol 33 (1) ◽

Author(s):

Bruno Silva de ASSIS ◽

Fabricio Ferreira COELHO ◽

Vagner Birk JEISMANN ◽

Jaime Arthur Pirola KRUGER ◽

Gilton Marques FONSECA ◽

...

Keyword(s):

Liver Resection ◽

Propensity Score ◽

Minimally Invasive ◽

Hospital Stay ◽

Propensity Score Matching ◽

Operative Time ◽

Perioperative Complications ◽

Open Liver Resection ◽

Minimally Invasive Liver Surgery ◽

Propensity Score Matching Analysis

ABSTRACT Background: There have been an increasing number of articles that demonstrate the potential benefits of minimally invasive liver surgery in recent years. Most of the available evidence, however, comes from retrospective observational studies susceptible to bias, especially selection bias. In addition, in many series, several modalities of minimally invasive surgery are included in the same comparison group. Aim: To compare the perioperative results (up to 90 days) of patients submitted to total laparoscopic liver resection with those submitted to open liver resection, matched by propensity score matching (PSM). Method: Consecutive adult patients submitted to liver resection were included. PSM model was constructed using the following variables: age, gender, diagnosis (benign vs. malignant), type of hepatectomy (minor vs. major), and presence of cirrhosis. After matching, the groups were redefined on a 1:1 ratio, by the nearest method. Results: After matching, 120 patients were included in each group. Those undergoing total laparoscopic surgery had shorter operative time (286.8±133.4 vs. 352.4±141.5 minutes, p<0.001), shorter ICU stay (1.9±1.2 vs. 2.5±2.2days, p=0.031), shorter hospital stay (5.8±3.9 vs. 9.9±9.3 days, p<0.001) and a 45% reduction in perioperative complications (19.2 vs. 35%, p=0.008). Conclusion: Total laparoscopic liver resections are safe, feasible and associated with shorter operative time, shorter ICU and hospital stay, and lower rate of perioperative complications.

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Short-term Outcomes after Minimally-invasive Liver Resection for Single Small Hepatocellular Carcinoma: An Analysis from the IGoMILS (Italian Group of Minimally Invasive Liver Surgery) Registry

HPB ◽

10.1016/j.hpb.2020.11.095 ◽

2021 ◽

Vol 23 ◽

pp. S40

Author(s):

F. Giuliante ◽

F. Ratti ◽

E. Panettieri ◽

A. Ferrero ◽

A. Guglielmi ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Minimally Invasive ◽

Liver Surgery ◽

Small Hepatocellular Carcinoma ◽

Short Term ◽

Minimally Invasive Liver Surgery ◽

Minimally Invasive Liver Resection

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Robotic and laparoscopic liver surgery for colorectal liver metastases: an experience from a German Academic Center

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02113-1 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Mirhasan Rahimli ◽

Aristotelis Perrakis ◽

Vera Schellerer ◽

Andrew Gumbs ◽

Eric Lorenz ◽

...

Keyword(s):

Abdominal Surgery ◽

Minimally Invasive ◽

Liver Surgery ◽

Colorectal Liver Metastases ◽

Survival Rates ◽

Long Term Outcomes ◽

Short Term ◽

Minimally Invasive Liver Surgery ◽

Previous Abdominal Surgery

Abstract Background Minimally invasive liver surgery (MILS) in the treatment of colorectal liver metastases (CRLM) is increasing in incidence. The aim of this work was to present our experience by reporting short-term and long-term outcomes after MILS for CRLM with comparative analysis of laparoscopic (LLS) and robotic liver surgery (RLS). Methods Twenty-five patients with CRLM, who underwent MILS between May 2012 and March 2020, were selected from our retrospective registry of minimally invasive liver surgery (MD-MILS). Thirteen of these patients underwent LLS and 12 RLS. Short-term and long-term outcomes of both groups were analyzed. Results Operating time was significantly longer in the RLS vs. the LLS group (342.0 vs. 200.0 min; p = 0.004). There was no significant difference between the laparoscopic vs. the robotic group regarding length of postoperative stay (8.8 days), measured blood loss (430.4 ml), intraoperative blood transfusion, overall morbidity (20.0%), and liver surgery related morbidity (4%). The mean BMI was 27.3 (range from 19.2 to 44.8) kg/m2. The 30-day mortality was 0%. R0 resection was achieved in all patients (100.0%) in RLS vs. 10 patients (76.9%) in LLS. Major resections were carried out in 32.0% of the cases, and 84.0% of the patients showed intra-abdominal adhesions due to previous abdominal surgery. In 24.0% of cases, the tumor was bilobar, the maximum number of tumors removed was 9, and the largest tumor was 8.5 cm in diameter. The 1-, 3- and 5-year overall survival rates were 84, 56.9, and 48.7%, respectively. The 1- and 3-year overall recurrence-free survival rates were 49.6 and 36.2%, respectively, without significant differences between RLS vs. LLS. Conclusion Minimally invasive liver surgery for CRLM is safe and feasible. Minimally invasive resection of multiple lesions and large tumors is also possible. RLS may help to achieve higher rates of R0 resections. High BMI, previous abdominal surgery, and bilobar tumors are not a barrier for MILS. Laparoscopic and robotic liver resections for CRLM provide similar long-term results which are comparable to open techniques.

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Technical feasibility and short-term outcomes of laparoscopic isolated caudate lobe resection: an IgoMILS (Italian Group of Minimally Invasive Liver Surgery) registry-based study

Surgical Endoscopy ◽

10.1007/s00464-021-08434-w ◽

2021 ◽

Author(s):

Andrea Ruzzenente ◽

◽

Andrea Ciangherotti ◽

Luca Aldrighetti ◽

Giuseppe Maria Ettorre ◽

...

Keyword(s):

Minimally Invasive ◽

Liver Metastases ◽

Hospital Stay ◽

Complication Rate ◽

Liver Surgery ◽

Colorectal Liver Metastases ◽

Caudate Lobe ◽

Open Group ◽

Perioperative Outcomes ◽

Minimally Invasive Liver Surgery

Abstract Background Although isolated caudate lobe (CL) liver resection is not a contraindication for minimally invasive liver surgery (MILS), feasibility and safety of the procedure are still poorly investigated. To address this gap, we evaluate data on the Italian prospective maintained database on laparoscopic liver surgery (IgoMILS) and compare outcomes between MILS and open group. Methods Perioperative data of patients with malignancies, as colorectal liver metastases (CRLM), hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), non-colorectal liver metastases (NCRLM) and benign liver disease, were retrospectively analyzed. A propensity score matching (PSM) analysis was performed to balance the potential selection bias for MILS and open group. Results A total of 224 patients were included in the study, 47 and 177 patients underwent MILS and open isolated CL resection, respectively. The overall complication rate was comparable between the two groups; however, severe complication rate (Dindo–Clavien grade ≥ 3) was lower in the MILS group (0% versus 6.8%, P = ns). In-hospital mortality was 0% in both groups and mean hospital stay was significantly shorter in the MILS group (P = 0.01). After selection of 42 MILS and 43 open CL resections by PSM analysis, intraoperative and postoperative outcomes remained similar except for the hospital stay which was not significantly shorter in MILS group. Conclusions This multi-institutional cohort study shows that MILS CL resection is feasible and safe. The surgical procedure can be technically demanding compared to open resection, whereas good perioperative outcomes can be achieved in highly selected patients.

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