Minimal Invasiveness of Laparoscopic Left Hepatic Lobectomy: A Special Reference to Systemic Inflammatory Response Syndrome

Tohru Utsunomiya, MD, Mitsuo Shimada, MD, Satoru Imura, MD, Yuji Morine, MD, Tetsuya Ikemoto, MD, Jun Hanaoka, MD, Shuichi i Iwahash, MD, Yu Saito, MD, Nobuhiro Kurita, MD, Hidenori Miyake, MD. Department of Surgery, The University of Tokushima

We have reported in the 2010 SAGES Annual Meeting that both laparoscopic left lateral segmentectomy (Lap-LLS) and laparoscopic left hepatic lobectomy (Lap-LL) are safe and feasible procedures by utilizing basic techniques and usual devices in open hepatectomy, and can be standard for selected patients. In this study, we examined the surgical invasiveness of the Lap-LL in comparison with that of the open-LL.
[Patients and Methods]
Five successive patients underwent Lap–LL for primary liver cancer from April 2004 to March 2010. During the same period, 10 patients with primary liver cancer underwent open–LL. We compared the following two issues between the 2 groups; (1) operative variables, such as operative time and blood loss, and (2) surgical invasiveness. We evaluated the surgical invasiveness as an incidence of systemic inflammatory response syndrome (SIRS) and time to walk independently after these surgical procedures.
(1) Operative variables: Compared with the open-LL, operative time was significantly shorter (243 min vs. 351 min, p < 0.05) and blood loss was significantly less in the Lap-LL (80 g vs. 324g, p < 0.05). There was no significant difference in the postoperative complication rates or postoperative hospital stay between the groups. (2) Surgical invasiveness: Mean of the heart rate of 1POD in the Lap-LL (61 beats/min) was markedly (p < 0.05) less than that in the open-LL (84 beats /min). Similar tendency was observed in 3POD (P = 0.052). The percentage complicating SIRS in the Lap-LL (0 %) was significantly (p < 0.05) less than that in the open-LL (40%). Mean of the time to walk independently in the Lap-LL (2 days) was shorter than that in the open-LL (3.9 days).
Lap-LL is a safer and less invasive surgical procedure because the incidence of SIRS during early postoperative periods was significantly less and time to walk after Lap-LL was much shorter compared to those of open-LL.

Session: Poster
Program Number: P351
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