Laparoscopic Major Hepatectomy: Do Not Underestimate the Impact of Specimen Extraction Site

  • Théophile GuilbaudEmail author
  • Carlotta Feretti
  • Waclaw Holowko
  • Giovanni Maria Garbarino
  • Ugo Marchese
  • Anthony Sarran
  • Marc Beaussier
  • Brice Gayet
  • David Fuks
Original Scientific Report



In laparoscopic major hepatectomy, analysis of outcomes according to specimen extraction site remains poorly described. The aim was to compare postoperative outcomes according to specimen extraction site.


From 2000 to 2017, all laparoscopic major hepatectomies were reviewed and postoperative outcomes were analyzed according to specimen extraction site: subcostal (Group 1), midline (Group 2), or suprapubic (Group 3) incision.


Among 163 patients, 15 (9.2%) belonged to Group 1, 49 (30.1%) in Group 2, and 99 (60.7%) in Group 3. The proportion of right-sided, left-sided, or central hepatectomies, mortality, and overall and severe complications were comparable between groups. Group 1 had larger tumors (61 vs. 38 vs. 47 mm; P = 0.014), higher operative time (338 vs. 282 vs. 260 min; P < 0.008), higher adjacent organ resection rate (46.6 vs. 16.3 vs. 7.1%; P < 0.001), and tended to increase pulmonary complications (40.0 vs. 12.2 vs. 18.2%; P = 0.064). In Group 2, a previous midline incision scar was more frequently used for specimen extraction site (65.3 vs. 26.6 and 30.3%, Group 1 and 3; P < 0.001). Postoperative incisional hernia was observed in 16.4% (n = 23) and was more frequent in Group 2 (26.6 vs. 6.6% and 10.1%, Group 1 and Group 3; P = 0.030). Finally, Group 2 (HR 2.63, 95% CI 1.41–3.53; P = 0.032) was the only independent predictive factor of postoperative incisional hernia.


While using a previous incision makes sense, the increased risk of postoperative incisional hernia after midline incision promotes the suprapubic incision.


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from patients involved in this study.


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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Théophile Guilbaud
    • 1
    • 2
    • 5
    Email author
  • Carlotta Feretti
    • 1
    • 2
  • Waclaw Holowko
    • 1
    • 2
  • Giovanni Maria Garbarino
    • 1
    • 2
  • Ugo Marchese
    • 1
    • 2
  • Anthony Sarran
    • 3
  • Marc Beaussier
    • 4
  • Brice Gayet
    • 1
    • 2
  • David Fuks
    • 1
    • 2
  1. 1.Department of Digestive, Oncological and Metabolic SurgeryInstitut Mutualiste MontsourisParisFrance
  2. 2.Université Paris DescartesParisFrance
  3. 3.Department of Radiology and Medical ImagingInstitut Mutualiste MontsourisParisFrance
  4. 4.Department of AnesthesiologyInstitut Mutualiste MontsourisParisFrance
  5. 5.Department of Digestive DiseaseInstitut Mutualiste Montsouris, Université Paris DescartesParisFrance

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