Safety and Efficacy of the Hand-Assisted Laparoscopic Approach for Repeat Hepatectomy: A Propensity Score Matching Analysis.

Abstract

Laparoscopic liver surgery following previous resections poses significant challenges due to adhesions and altered anatomy. Hand-assisted laparoscopic liver resection (HALR) combines the tactile advantages of open surgery with minimally invasive techniques, potentially benefitting patients undergoing repeat hepatectomy. This study aims to assess the safety and efficacy of HALR for repeat hepatectomy and compare these outcomes with those of an open liver resection (OR). A retrospective study included patients who underwent repeat hepatectomy via HALR or OR from January 2013 to December 2022. Patient characteristics and outcomes were compared before and after propensity score matching. The primary outcome was 90-day morbidity. Surgical difficulty was stratified using the Institut Mutualiste Montsouris (IMM) classification into grade I (low), grade II (intermediate), and grade III (high). The study included 248 patients: 112 in the HALR group and 136 in the OR group. Conversion to open occurred in 2 cases (1.8%). After matching, 76 HALR patients were compared with 76 OR patients. HALR patients had a longer operative time (median: 402 vs. 277 min and p < 0.001), shorter postoperative hospital stay (median: 8.0 vs. 9.0 days and p < 0.001), and higher hospital cost (median: $10,607 vs. $6260 and p < 0.001). No significant differences in 90-day morbidity or readmission rates. Risk factors for 90-day morbidity included the ASA score ≥ 2, diabetes, IMM grade 3, and portal hypertension. HALR for repeat hepatectomy is feasible and safe, with perioperative outcomes comparable to OR. HALR may be a viable alternative for selected patients.