Abstract: Objective:To investigate the application value of the adhesive suspension of left lateral lobe of liver in transumbilical single-port laparoscopic left upper abdominal surgery.
Methods:The retrospective cross-sectional study was conducted. The clinical data of 112 patients who underwent single-port laparoscopic left upper abdominal surgery in the Shengjing Hospital of China Medical University between January 2010 and October 2016 were collected. Patients underwent single-port laparoscopic left upper abdominal surgery, and intraoperative surgical fields were exposed through adhesive suspension of left lateral lobe of liver. Observation indicators: (1) intraoperative situations: surgical completion, surgical procedures, time of liver adhesive suspension, total operation time and intraoperative liver adhesive suspension-related complications; (2) postoperative situations: pre- and post-operative alanine transaminase (ALT) and aspartate transaminase (AST) levels, hospital expenses and duration of hospital stay; (3) follow-up: number of patients with follow-up, follow-up time, complications during follow-up. Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications up to June 2017. Measurement data with normal distribution were represented as ±s. Repeated measurement data were analyzed using the repeated measures ANOVA.
Results:(1) Intraoperative situations: 112 patients underwent successfully single-port laparoscopic left upper abdominal surgery, without conversion to multi-port surgery or open surgery. Of 112 patients, 30, 23, 13, 11, 11, 10, 3, 3, 3, 3, 1 and 1 underwent radical resection of gastric cancer, partial gastrectomy, esophageal Heller myotomy + Dor fundo-plication, subtotal gastrectomy, resection of body and tail of pancreas, paraoesophageal hiatal hernia repair + fundoplication, total gastrectomy, splenectomy, splenectomy + devascularization, pancreatic tail resection, simple fundoplication and splenic artery aneurysm resection, respectively. Time of liver adhesive suspension and total operation time in 112 patients were respectively (1.4±0.4)minutes and (192.0±91.3) minutes. There was no hepatic laceration, hepatic subcapsular hematoma and other complications. (2) Postoperative situations: of 112 patients, preoperative ALT and AST levels of 6 patients were mildly elevated, postoperative ALT and AST levels in 2 of 6 patients returned to normal, that in 1 of 6 patients were elevated at day 1 postoperatively and returned to normal at day 3 postoperatively, and that in 2 of 6 patients remained mildly elevated at week 1 postoperatively; preoperative ALT and AST levels of 106 patients were normal, ALT and AST levels in 31 of 106 patients were elevated at day 1 postoperatively (that in 28 patients returned to normal within week 1 postoperatively, and that in 3 patients remained mildly elevated), and that in 75 of 106 patients returned to normal. ALT and AST levels of 112 patients were (16±11)U/L, (18±7)U/L before operation and (31±21)U/L, (34±26)U/L at day 1 postoperatively and (19±17)U/L, (19±12)U/L at week 1 postoperatively, respectively, with statistically significant differences in ALT and AST levels before operation and at day 1 postoperatively (F=36.353, 29.792, P<0.05), and no statistically significant difference in ALT and AST levels before operation and at week 1 postoperatively (F=2.905, 1.284, P>0.05). Hospital expenses, surgery-related expenses and duration of hospital stay were (45 231±20 440)yuan, (23 511±9 609)yuan and (6.0±1.9)days, respectively. (3) Follow-up: 112 patients were followed up for 1.0-3.0 months, with a median time of 1.6 months. During the follow-up, there were no obvious complications.
Conclusions:Adhesive suspension of left lateral lobe of liver is simple and safe, with satisfactory exposure effects, and it is suitable for the better operative field exposure in single-port laparoscopic left upper abdominal surgery.