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Laparoscopic versus open left lateral segmentectomy.

Carswell KA, Sagias FG, Murgatroyd B, Rela M, Heaton N, Patel AG - BMC Surg (2009)

Bottom Line: The conversion rate was 10% (1/10).Surgical margins for all lesions were clear.There was no mortality.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Liver Studies, King's College Hospital, London, UK. kirstincarswell@hotmail.com

ABSTRACT

Background: Laparoscopic liver surgery is becoming increasingly common. This cohort study was designed to directly compare perioperative outcomes of the left lateral segmentectomy via laparoscopic and open approach.

Methods: Between 2002 and 2006 43 left lateral segmentectomies were performed at King's College Hospital. Those excluded from analysis included previous liver resections, polycystic liver disease, liver cirrhosis and synchronous operations. Of 20 patients analysed, laparoscopic (n = 10) were compared with open left lateral segmentectomy (n = 10). Both groups had similar patient characteristics.

Results: Morbidity rates were similar with no wound or chest infection in either group. The conversion rate was 10% (1/10). There was no difference in operating time between the groups (median time 220 minutes versus 179 minutes, p = 0.315). Surgical margins for all lesions were clear. Less postoperative opiate analgesics were required in the laparoscopic group (median 2 days versus 5 days, p = 0.005). The median postoperative in-hospital stay was less in the laparoscopic group (6 days vs 9 days, p = 0.005). There was no mortality.

Conclusion: Laparoscopic left lateral segmentectomy is safe and feasible. Laparoscopic patients may benefit from requiring less postoperative opiate analgesia and a shorter post-operative in-hospital stay.

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Related in: MedlinePlus

Attrition diagram.
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Figure 1: Attrition diagram.

Mentions: We undertook a retrospective cohort study of the left lateral segmentectomies in our institution between July 2002 and October 2006 (n = 43). Cases were included on an intention to treat basis however, in an attempt to reduce bias, patients having previous liver resections (n = 2), synchronous operations (n = 14), polycystic liver disease (n = 3), liver cirrhosis (n = 3) and hand port assisted procedure (n = 1) were excluded (see figure 1). This resulted in 20 left lateral segmentectomies for comparison, 10 in the laparoscopic (LG) and 10 in the open group (OG). Selection was based on referral to the individual consultants with all laparoscopic operations performed by a single surgeon (AGP) and open operations under the care of two surgeons (NH, MR). Selection-bias was minimised by the random referral policy to the individual surgeons over this time period. All cases were discussed at the liver multi-disciplinary meeting pre-operatively. A detailed review of the medical records was conducted. Data collection included patient characteristics, site of lesion, operative details, postoperative analgesic requirements, morbidity and mortality, postoperative in-hospital stay, pathology of specimen, weight of resected specimen and tumour clearance margins. Ethical approval was not required.


Laparoscopic versus open left lateral segmentectomy.

Carswell KA, Sagias FG, Murgatroyd B, Rela M, Heaton N, Patel AG - BMC Surg (2009)

Attrition diagram.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2742511&req=5

Figure 1: Attrition diagram.
Mentions: We undertook a retrospective cohort study of the left lateral segmentectomies in our institution between July 2002 and October 2006 (n = 43). Cases were included on an intention to treat basis however, in an attempt to reduce bias, patients having previous liver resections (n = 2), synchronous operations (n = 14), polycystic liver disease (n = 3), liver cirrhosis (n = 3) and hand port assisted procedure (n = 1) were excluded (see figure 1). This resulted in 20 left lateral segmentectomies for comparison, 10 in the laparoscopic (LG) and 10 in the open group (OG). Selection was based on referral to the individual consultants with all laparoscopic operations performed by a single surgeon (AGP) and open operations under the care of two surgeons (NH, MR). Selection-bias was minimised by the random referral policy to the individual surgeons over this time period. All cases were discussed at the liver multi-disciplinary meeting pre-operatively. A detailed review of the medical records was conducted. Data collection included patient characteristics, site of lesion, operative details, postoperative analgesic requirements, morbidity and mortality, postoperative in-hospital stay, pathology of specimen, weight of resected specimen and tumour clearance margins. Ethical approval was not required.

Bottom Line: The conversion rate was 10% (1/10).Surgical margins for all lesions were clear.There was no mortality.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Liver Studies, King's College Hospital, London, UK. kirstincarswell@hotmail.com

ABSTRACT

Background: Laparoscopic liver surgery is becoming increasingly common. This cohort study was designed to directly compare perioperative outcomes of the left lateral segmentectomy via laparoscopic and open approach.

Methods: Between 2002 and 2006 43 left lateral segmentectomies were performed at King's College Hospital. Those excluded from analysis included previous liver resections, polycystic liver disease, liver cirrhosis and synchronous operations. Of 20 patients analysed, laparoscopic (n = 10) were compared with open left lateral segmentectomy (n = 10). Both groups had similar patient characteristics.

Results: Morbidity rates were similar with no wound or chest infection in either group. The conversion rate was 10% (1/10). There was no difference in operating time between the groups (median time 220 minutes versus 179 minutes, p = 0.315). Surgical margins for all lesions were clear. Less postoperative opiate analgesics were required in the laparoscopic group (median 2 days versus 5 days, p = 0.005). The median postoperative in-hospital stay was less in the laparoscopic group (6 days vs 9 days, p = 0.005). There was no mortality.

Conclusion: Laparoscopic left lateral segmentectomy is safe and feasible. Laparoscopic patients may benefit from requiring less postoperative opiate analgesia and a shorter post-operative in-hospital stay.

Show MeSH
Related in: MedlinePlus