Fully laparoscopic left hepatectomy - a technical reference proposed for standard practice compared to the open approach: a retrospective propensity score model

Roberto Valente, Robert Sutcliffe, Eric Levesque, Mara Costa, Nicola De' Angelis, Claude Tayar, Daniel Cherqui, Alexis Laurent

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)347-355
Number of pages9
JournalHPB
Volume20
Issue number4
DOIs
Publication statusPublished - Apr 2018

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Propensity Score
Hepatectomy
Conversion to Open Surgery
Safety
Hepatic Veins
Mortality
Ligaments
Laparoscopy
Dissection
Histology
Fibrosis
Weights and Measures
Neoplasms
Surgeons
Lead

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Fully laparoscopic left hepatectomy - a technical reference proposed for standard practice compared to the open approach : a retrospective propensity score model. / Valente, Roberto; Sutcliffe, Robert; Levesque, Eric; Costa, Mara; De' Angelis, Nicola; Tayar, Claude; Cherqui, Daniel; Laurent, Alexis.

In: HPB, Vol. 20, No. 4, 04.2018, p. 347-355.

Research output: Contribution to journalArticle

Valente, Roberto ; Sutcliffe, Robert ; Levesque, Eric ; Costa, Mara ; De' Angelis, Nicola ; Tayar, Claude ; Cherqui, Daniel ; Laurent, Alexis. / Fully laparoscopic left hepatectomy - a technical reference proposed for standard practice compared to the open approach : a retrospective propensity score model. In: HPB. 2018 ; Vol. 20, No. 4. pp. 347-355.
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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{\circledR} 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.",
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T2 - a retrospective propensity score model

AU - Valente, Roberto

AU - Sutcliffe, Robert

AU - Levesque, Eric

AU - Costa, Mara

AU - De' Angelis, Nicola

AU - Tayar, Claude

AU - Cherqui, Daniel

AU - Laurent, Alexis

N1 - Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

PY - 2018/4

Y1 - 2018/4

N2 - 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.

AB - 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.

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