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Abstract：
BACKGROUND: Hand-assisted laparoscopic surgery (HALS) is known as a useful option. However, the outcome and predictor of conversion to HALS in laparoscopic liver resection (LLR) are unclear.
METHODS: Data from consecutive patients who planned pure LLR between 2011 and 2020 were retrospectively reviewed. Univariate and multivariate analyses were performed and compared pure LLR, HALS, and converted open liver resection (OLR).
RESULTS: Among the 169 LLRs, conversion to HALS was performed in 19 (11.2%) and conversion to OLR in 16 (9.5%). The most frequent reasons for conversion to HALS were failure to progress (11 cases). Subsequently, bleeding (3 cases), severe adhesion (2 cases), and oncological factors (2 cases) were the reasons. In the multivariable analysis, the tumor located in segments 7 or 8 (p = 0.002) was evaluated as a predictor of conversion to HALS. Pure LLR and HALS were associated with less blood loss than conversion to OLR (p = 0.005 and p = 0.014, respectively). However, there was no significant difference in operation time, hospital stay, or severe complications.
CONCLUSIONS: The predictor of conversion to HALS was a tumor located in segments 7 or 8. The outcome of conversion to HALS was not inferior to pure LLR in terms of bleeding, operation time, hospital stay, or severe complication.
METHODS: Data from consecutive patients who planned pure LLR between 2011 and 2020 were retrospectively reviewed. Univariate and multivariate analyses were performed and compared pure LLR, HALS, and converted open liver resection (OLR).
RESULTS: Among the 169 LLRs, conversion to HALS was performed in 19 (11.2%) and conversion to OLR in 16 (9.5%). The most frequent reasons for conversion to HALS were failure to progress (11 cases). Subsequently, bleeding (3 cases), severe adhesion (2 cases), and oncological factors (2 cases) were the reasons. In the multivariable analysis, the tumor located in segments 7 or 8 (p = 0.002) was evaluated as a predictor of conversion to HALS. Pure LLR and HALS were associated with less blood loss than conversion to OLR (p = 0.005 and p = 0.014, respectively). However, there was no significant difference in operation time, hospital stay, or severe complications.
CONCLUSIONS: The predictor of conversion to HALS was a tumor located in segments 7 or 8. The outcome of conversion to HALS was not inferior to pure LLR in terms of bleeding, operation time, hospital stay, or severe complication.
摘要：
背景：手助腹腔镜手术（HALS）是一种有用的选择。然而,腹腔镜肝切除术(LLR)的转归和转换为HALS的预测因素尚不清楚.
方法：回顾性分析了2011年至2020年计划纯LLR的连续患者的数据。进行了单变量和多变量分析，并比较了纯LLR，HALS,和改良的开放式肝切除术（OLR）。
结果：在169个LLR中，19例(11.2%)转化为HALS,16例(9.5%)转化为OLR.转换为HALS的最常见原因是进展失败（11例）。随后，出血（3例），严重粘连（2例），肿瘤因素（2例）是原因。在多变量分析中，位于第7或8段(p=0.002)的肿瘤被评估为转化为HALS的预测因子。与转化为OLR相比，纯LLR和HALS的失血量较少（分别为p=0.005和p=0.014）。然而,手术时间无显著差异,住院,或严重的并发症。
结论：转化为HALS的预测因子是位于第7或8段的肿瘤。在出血方面，转换为HALS的结果不亚于纯LLR，操作时间,住院,或严重并发症。
方法：回顾性分析了2011年至2020年计划纯LLR的连续患者的数据。进行了单变量和多变量分析，并比较了纯LLR，HALS,和改良的开放式肝切除术（OLR）。
结果：在169个LLR中，19例(11.2%)转化为HALS,16例(9.5%)转化为OLR.转换为HALS的最常见原因是进展失败（11例）。随后，出血（3例），严重粘连（2例），肿瘤因素（2例）是原因。在多变量分析中，位于第7或8段(p=0.002)的肿瘤被评估为转化为HALS的预测因子。与转化为OLR相比，纯LLR和HALS的失血量较少（分别为p=0.005和p=0.014）。然而,手术时间无显著差异,住院,或严重的并发症。
结论：转化为HALS的预测因子是位于第7或8段的肿瘤。在出血方面，转换为HALS的结果不亚于纯LLR，操作时间,住院,或严重并发症。
