Correlation Between Type of Retrieval Incision and Postoperative Outcomes in Laparoscopic Liver Surgery: A Critical...

At the end of a laparoscopic major hepatectomy, an incision wide enough for specimen retrieval is required. Classically, Pfannenstiel (PF) incision is the type of access favored as service incision in laparoscopy. However, in specific settings the use of a midline (ML) incision can be favorable, with doubtful impaction on the outcomes of a purely laparoscopic operation. The aim of this study was to investigate on clinical outcomes after laparoscopic hemihepatectomies using PF/ML incisions in comparison with open. The institutional clinical database of the Hepatobiliary Division at San Raffaele Hospital (Milan, Italy) was retrospectively reviewed identifying cases of laparoscopic and open hemihepatectomies. Three analyses were performed: whole laparoscopic versus open; ML versus open; PF versus ML. Clinical outcomes such as intraoperative blood loss, operative time, postoperative morbidity, motility resumption, perceived pain, and length of stay (LOS) were used for comparisons. Laparoscopy was confirmed to be superior to open approach also in the present series in terms of lower blood loss (300 versus 400 mL, P = .041), fewer complications (14.2% versus 25.9%, P = .024), shorter hospitalization (5 versus 7 days, P = .033), and enhanced recovery in terms of better pain control (P = .035) and mobility resumption (P = .047). Similar outcomes were observed comparing ML alone with open (estimated blood loss 300 mL versus 400 mL, P = .039; complications 13.1% versus 25.9%, P = .037; LOS 5 days versus 7 days, P = .04; lower pain perception, P = .048 and faster mobility resumption, P = .046). No significant differences were observed in postoperative outcomes of PF versus ML. Suprapubic and ML incisions at the end of a pure laparoscopic case lead to comparable outcomes between each other. The adoption of ML incision for specimen retrieval does not affect outcomes of minimal invasiveness.