Abstract: Objective:To investigate application value of cutter stapler in transumbilical single port laparoscopic left lateral lobectomy.
Methods:The retrospective cohort study was adopted. The clinical data of 26 patients who underwent transumbilical single port laparoscopic left lateral lobectomy at the Shengjing Hospital of China Medical University from January 2010 to February 2016 were collected. Nine patients who received liver parenchyma using ultrasonic knife were allocated into the ultrasonic knife group, 17 patients who received liver parenchyma using cutter stapler were allocated into the cutter stapler group. Observation indicators included (1) operation situations: operation time, volume of intraoperative blood loss, postoperative complications, time of postoperative bowel function recovery, time of abdominal cavity drainage tube removal, duration of postoperative hospital stay. (2) Postoperative reexamination and followup: ultrasound or computed tomography (CT) examination was performed when necessary for detecting local exudation or encapsulated effusion. The patients were followed up at postoperative 1 to 3 months with telephone interview for whether with abdominal distension or abdominal pain till March 2016. Measurement data with normal distribution were presented as ±s and analyzed by using t test. Measurement data with skewed distribution were presented as M (range) and analyzed by ranksum text. Comparison of count data was analyzed by the Fisher′s exact probility.
Results:(1) Operation situations: all the 26 patients received transumbilical single port laparoscopic left lateral lobectomy with no conversion to porous laparoscopic surgery or open surgery. The operation time was (114±54)minutes, the volume of intraoperative blood loss was 100 mL (range, 20-800 mL), and no intraoperative blood transfusion was adopted. The operation time and volume of intraoperative blood loss were (135±43)minutes and 200 mL (range, 20- 800 mL) in the ultrasonic knife group, (103±57)minutes and 100 mL (range, 20-300 mL) in the cutter stapler group, respectively, showing no statistically significant difference between the 2 groups (t=1500, Z= -0961, P>005). All the 26 patients recovered well after surgery, with no postoperative complications as postoperative hemorrhage, bile leakage, incision infection or death. The time of postoperative bowel function recovery, time of abdominal cavity drainage tube removal and duration of postoperative hospital stay was (15±04)days, (58±20)days and (70±20)days in the ultrasonic knife group, (11±03)days, (41± 11)days and (49±14)days in the cutter stapler group, respectively, showing statistically significant differences between the 2 groups (t=2599, 2875, 3036, P<005). (2) Postoperative reexamination and followup: of 26 patients, 11 patients received ultrasound or CT examination after surgery and detected no obvious local exudation or encapsulated effusion, with no special treatment. The other 15 patients didn′t receive ultrasound or CT examination. All the 26 patients were followed up for 1-3 months, with no occurrence of upper abdominal distension or abdominal pain.
Conclusion:Transumbilical single port laparoscopic left lateral lobectomy is safe and feasible, the application of cutter stapler is helpful to safety and success of the operation, further accelerating the postoperative recovery of patients.