The Shift from Multiport to Single Port Increases the Amount of Bleeding in Laparoscopic Major Hepatectomy
Bleeding is a negative outcome predictor in liver surgery. Reduction in the abdominal wall trauma in major hepatectomy is challenging but might offer possible benefits for the patient. This study was conducted to assess hemostasis techniques in single-port major hepatectomies (SP-MajH) as compared t...
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| Published in: | Journal of clinical medicine Vol. 10; no. 3; p. 374 |
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| Abstract | Bleeding is a negative outcome predictor in liver surgery. Reduction in the abdominal wall trauma in major hepatectomy is challenging but might offer possible benefits for the patient. This study was conducted to assess hemostasis techniques in single-port major hepatectomies (SP-MajH) as compared to multiport major hepatectomies (MP-MajH).
The non-randomized study comprised 34 SP-MajH in selected patients; 14 MP-MajH served as the control group. Intraoperative blood loss and number of blood units transfused served as the primary endpoints. Secondary endpoints were complications and oncologic five-year outcome.
All resections were completed without converting to open surgery. Time for hepatectomy did not differ between SP-MajH and MP-MajH. Blood loss and number of patients with blood loss > 25 mL were significantly larger in MP-MajH (
= 0.001). In contrast, bleeding control was more difficult in SP-MajH, resulting in more transfusions (
= 0.008). One intestinal laceration (SP-MajH) accounted for the only intraoperative complication; 90-day mortality was zero. Postoperative complications were noted in total in 20.6% and 21.4% of patients for SP-MajH and MP-MajH, respectively. No incisional hernia occurred. During a median oncologic follow-up at 61 and 56 months (SP-MajH and MP-MajH), no local tumor recurrence was observed.
SP-MajH requires sophisticated techniques to ensure operative safety. Substantial blood loss requiring transfusion is more likely to occur in SP-MajH than in MP-MajH. |
|---|---|
| AbstractList | Background: Bleeding is a negative outcome predictor in liver surgery. Reduction in the abdominal wall trauma in major hepatectomy is challenging but might offer possible benefits for the patient. This study was conducted to assess hemostasis techniques in single-port major hepatectomies (SP-MajH) as compared to multiport major hepatectomies (MP-MajH). Methods: The non-randomized study comprised 34 SP-MajH in selected patients; 14 MP-MajH served as the control group. Intraoperative blood loss and number of blood units transfused served as the primary endpoints. Secondary endpoints were complications and oncologic five-year outcome. Results: All resections were completed without converting to open surgery. Time for hepatectomy did not differ between SP-MajH and MP-MajH. Blood loss and number of patients with blood loss > 25 mL were significantly larger in MP-MajH (p = 0.001). In contrast, bleeding control was more difficult in SP-MajH, resulting in more transfusions (p = 0.008). One intestinal laceration (SP-MajH) accounted for the only intraoperative complication; 90-day mortality was zero. Postoperative complications were noted in total in 20.6% and 21.4% of patients for SP-MajH and MP-MajH, respectively. No incisional hernia occurred. During a median oncologic follow-up at 61 and 56 months (SP-MajH and MP-MajH), no local tumor recurrence was observed. Conclusions: SP-MajH requires sophisticated techniques to ensure operative safety. Substantial blood loss requiring transfusion is more likely to occur in SP-MajH than in MP-MajH. Background: Bleeding is a negative outcome predictor in liver surgery. Reduction in the abdominal wall trauma in major hepatectomy is challenging but might offer possible benefits for the patient. This study was conducted to assess hemostasis techniques in single-port major hepatectomies (SP-MajH) as compared to multiport major hepatectomies (MP-MajH). Methods: The non-randomized study comprised 34 SP-MajH in selected patients; 14 MP-MajH served as the control group. Intraoperative blood loss and number of blood units transfused served as the primary endpoints. Secondary endpoints were complications and oncologic five-year outcome. Results: All resections were completed without converting to open surgery. Time for hepatectomy did not differ between SP-MajH and MP-MajH. Blood loss and number of patients with blood loss > 25 mL were significantly larger in MP-MajH ( p = 0.001). In contrast, bleeding control was more difficult in SP-MajH, resulting in more transfusions ( p = 0.008). One intestinal laceration (SP-MajH) accounted for the only intraoperative complication; 90-day mortality was zero. Postoperative complications were noted in total in 20.6% and 21.4% of patients for SP-MajH and MP-MajH, respectively. No incisional hernia occurred. During a median oncologic follow-up at 61 and 56 months (SP-MajH and MP-MajH), no local tumor recurrence was observed. Conclusions: SP-MajH requires sophisticated techniques to ensure operative safety. Substantial blood loss requiring transfusion is more likely to occur in SP-MajH than in MP-MajH. Bleeding is a negative outcome predictor in liver surgery. Reduction in the abdominal wall trauma in major hepatectomy is challenging but might offer possible benefits for the patient. This study was conducted to assess hemostasis techniques in single-port major hepatectomies (SP-MajH) as compared to multiport major hepatectomies (MP-MajH). The non-randomized study comprised 34 SP-MajH in selected patients; 14 MP-MajH served as the control group. Intraoperative blood loss and number of blood units transfused served as the primary endpoints. Secondary endpoints were complications and oncologic five-year outcome. All resections were completed without converting to open surgery. Time for hepatectomy did not differ between SP-MajH and MP-MajH. Blood loss and number of patients with blood loss > 25 mL were significantly larger in MP-MajH ( = 0.001). In contrast, bleeding control was more difficult in SP-MajH, resulting in more transfusions ( = 0.008). One intestinal laceration (SP-MajH) accounted for the only intraoperative complication; 90-day mortality was zero. Postoperative complications were noted in total in 20.6% and 21.4% of patients for SP-MajH and MP-MajH, respectively. No incisional hernia occurred. During a median oncologic follow-up at 61 and 56 months (SP-MajH and MP-MajH), no local tumor recurrence was observed. SP-MajH requires sophisticated techniques to ensure operative safety. Substantial blood loss requiring transfusion is more likely to occur in SP-MajH than in MP-MajH. BACKGROUNDBleeding is a negative outcome predictor in liver surgery. Reduction in the abdominal wall trauma in major hepatectomy is challenging but might offer possible benefits for the patient. This study was conducted to assess hemostasis techniques in single-port major hepatectomies (SP-MajH) as compared to multiport major hepatectomies (MP-MajH). METHODSThe non-randomized study comprised 34 SP-MajH in selected patients; 14 MP-MajH served as the control group. Intraoperative blood loss and number of blood units transfused served as the primary endpoints. Secondary endpoints were complications and oncologic five-year outcome. RESULTSAll resections were completed without converting to open surgery. Time for hepatectomy did not differ between SP-MajH and MP-MajH. Blood loss and number of patients with blood loss > 25 mL were significantly larger in MP-MajH (p = 0.001). In contrast, bleeding control was more difficult in SP-MajH, resulting in more transfusions (p = 0.008). One intestinal laceration (SP-MajH) accounted for the only intraoperative complication; 90-day mortality was zero. Postoperative complications were noted in total in 20.6% and 21.4% of patients for SP-MajH and MP-MajH, respectively. No incisional hernia occurred. During a median oncologic follow-up at 61 and 56 months (SP-MajH and MP-MajH), no local tumor recurrence was observed. CONCLUSIONSSP-MajH requires sophisticated techniques to ensure operative safety. Substantial blood loss requiring transfusion is more likely to occur in SP-MajH than in MP-MajH. |
| Author | Gollegger, Emanuel Fischer, Katharina Obrist, Christian de Cillia, Michael Schirnhofer, Jan Kemmetinger, Vanessa Mittermair, Christof Weiss, Michael Brunner, Eberhard Weiss, Helmut Hell, Tobias |
| AuthorAffiliation | 1 Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria; christof.mittermair@bbsalz.at (C.M.); michael.weiss1@icloud.com (M.W.); jan.schirnhofer@bbsalz.at (J.S.); eberhard.brunner@bbsalz.at (E.B.); katharina.fischer@bbsalz.at (K.F.); christian.obrist@bbsalz.at (C.O.); michael.decillia@bbsalz.at (M.d.C.); vanessa.kemmetinger@bbsalz.at (V.K.); praxis@dr-gollegger.at (E.G.) 2 Department of Mathematics, University of Innsbruck, Technikerstrasse 13, 6020 Innsbruck, Austria; tobias.hell@uibk.ac.at |
| AuthorAffiliation_xml | – name: 2 Department of Mathematics, University of Innsbruck, Technikerstrasse 13, 6020 Innsbruck, Austria; tobias.hell@uibk.ac.at – name: 1 Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria; christof.mittermair@bbsalz.at (C.M.); michael.weiss1@icloud.com (M.W.); jan.schirnhofer@bbsalz.at (J.S.); eberhard.brunner@bbsalz.at (E.B.); katharina.fischer@bbsalz.at (K.F.); christian.obrist@bbsalz.at (C.O.); michael.decillia@bbsalz.at (M.d.C.); vanessa.kemmetinger@bbsalz.at (V.K.); praxis@dr-gollegger.at (E.G.) |
| Author_xml | – sequence: 1 givenname: Christof surname: Mittermair fullname: Mittermair, Christof organization: Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria – sequence: 2 givenname: Michael surname: Weiss fullname: Weiss, Michael organization: Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria – sequence: 3 givenname: Jan surname: Schirnhofer fullname: Schirnhofer, Jan organization: Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria – sequence: 4 givenname: Eberhard surname: Brunner fullname: Brunner, Eberhard organization: Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria – sequence: 5 givenname: Katharina surname: Fischer fullname: Fischer, Katharina organization: Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria – sequence: 6 givenname: Christian surname: Obrist fullname: Obrist, Christian organization: Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria – sequence: 7 givenname: Michael surname: de Cillia fullname: de Cillia, Michael organization: Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria – sequence: 8 givenname: Vanessa surname: Kemmetinger fullname: Kemmetinger, Vanessa organization: Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria – sequence: 9 givenname: Emanuel surname: Gollegger fullname: Gollegger, Emanuel organization: Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria – sequence: 10 givenname: Tobias orcidid: 0000-0002-2841-3670 surname: Hell fullname: Hell, Tobias organization: Department of Mathematics, University of Innsbruck, Technikerstrasse 13, 6020 Innsbruck, Austria – sequence: 11 givenname: Helmut surname: Weiss fullname: Weiss, Helmut organization: Surgical Department, St John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5010 Salzburg, Austria |
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| Keywords | hepatectomy radiofrequency pre-coagulation single-port laparoscopy |
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| Snippet | Bleeding is a negative outcome predictor in liver surgery. Reduction in the abdominal wall trauma in major hepatectomy is challenging but might offer possible... Background: Bleeding is a negative outcome predictor in liver surgery. Reduction in the abdominal wall trauma in major hepatectomy is challenging but might... BACKGROUNDBleeding is a negative outcome predictor in liver surgery. Reduction in the abdominal wall trauma in major hepatectomy is challenging but might offer... |
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| SubjectTerms | Abdomen Blood Clinical medicine Contraindications Hepatectomy Laparoscopy Liver Patient safety Surgery Sutures |
| Title | The Shift from Multiport to Single Port Increases the Amount of Bleeding in Laparoscopic Major Hepatectomy |
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