Open AccessEvolution and trends in the adoption of laparoscopic liver resection in Singapore: Analysis of 300 cases
Author(s) -
Brian K. P. Goh,
Zhongkai Wang,
Ye Xin Koh,
Kai Inn Lim
Publication year - 2021
Publication title -
annals, academy of medicine, singapore/annals of the academy of medicine, singapore
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.299
H-Index - 60
ISSN - 0304-4602
DOI - 10.47102/annals-acadmedsg.2021213
Subject(s) - medicine , surgery , concomitant , retrospective cohort study , laparoscopy , cohort , liver biopsy , biopsy , general surgery , radiology
: The introduction of laparoscopic surgery has changed abdominal surgery. We evaluatedthe evolution and changing trends associated with adoption of laparoscopic liver resection (LLR) andthe experience of a surgeon without prior LLR experience.Methods: A retrospective review of 310 patients who underwent LLR performed by a single surgeonfrom 2011 to 2020 was conducted. Exclusion criteria were patients who underwent laparoscopic liversurgeries such as excision biopsy, local ablation, drainage of abscesses and deroofing of liver cysts.There were 300 cases and the cohort was divided into 5 groups of 60 patients.Results: There were 288 patients who underwent a totally minimally invasive approach, including28 robotic-assisted procedures. Open conversion occurred for 13 (4.3%) patients; the conversion ratedecreased significantly from 10% in the initial period to 3.3% subsequently. There were 83 (27.7%)major resections and 131 (43.7%) resections were performed for tumours in the difficultposterosuperior location. There were 152 (50.7%) patients with previous abdominal surgery, including52 (17.3%) repeat liver resections for recurrent tumours, and 60 patients had other concomitantoperations. According to the Iwate criteria, 135 (44.7%) were graded as high/expert difficulty. Majormorbidity (>grade 3a) occurred in 12 (4.0%) patients and there was no 30-day mortality. Comparisonacross the 5 patient groups demonstrated a significant trend towards older patients, higher AmericanSociety of Anesthesiologists (ASA) score, increasing frequency of LLR with previous abdominalsurgery, increasing frequency of portal hypertension and huge tumours, decreasing blood loss anddecreasing transfusion rate across the study period. Surgeon experience (≤60 cases) and InstitutMutualiste Montsouris (IMM) high grade resections were independent predictors of open conversion.Open conversion was associated with worse perioperative outcomes such as increased blood loss,transfusion rate, morbidity and length of stay.Conclusion: LLR can be safely adopted for resections of all difficulty grades, including major resectionsand for tumours located in the difficult posterosuperior segments, with a low open conversion rate.Keywords: Laparoscopic hepatectomy, laparoscopic liver resection, robotic hepatectomy, robotic liverresection, Singapore