Long-term and short-term surgical outcomes of single-incision laparoscopic hepatectomy on anterolateral liver segments

  • Kuei-Yen Tsai
  • Hsin-An Chen
  • Wan-Yu Wang
  • Ming-Te HuangEmail author



Laparoscopic liver resection yields improved short-term surgical outcomes, whereas the reports about clinical benefits of single-incision laparoscopic hepatectomy (SILH) are scarce. This retrospective study is to compare the surgical outcomes of SILH with those of multi-incision laparoscopic hepatectomy (MILH).


The study included 54 patients who had undergone SILH and 184 patients who had undergone MILH between January 2010 and December 2017. Short-term outcomes were compared in those of patients who underwent left lateral sectionectomy and partial hepatectomy of segment 5–6. A subgroup analysis of hepatocellular carcinoma (HCC) was also performed for long-term outcome comparisons.


In those of patients who underwent left lateral sectionectomy, SILH group had less chronic hepatitis B (15.2 vs. 45.8%; p = 0.004), less liver cirrhosis (12.1 vs. 50.0%; p = 0.002), less tumor proximal to major vessel (6.1 vs. 29.2%; p = 0.018), shorter surgical time (113.2 ± 37.9 vs. 146.0 ± 50.5 min; p = 0.007), and shorter postoperative hospital stays (4.4 ± 1.1 vs. 5.4 ± 1.3 days; p = 0.002) compared with MILH group. In those of patients with tumor located at segment 5–6, no significant differences were observed in surgical time, blood loss, complications, and mortality. Single-incision laparoscopic partial hepatectomy was only associated with wider surgical margins (11.8 ± 7.0 vs. 5.3 ± 5.2 mm; p = 0.003). In the HCC subgroup, SILH had similar 1-, 3-, and 5-year overall survival and 1-, 3-, and 5-year recurrence-free survival rates compared with patients who had undergone MILH.


The study demonstrates the safety and feasibility of single-incision laparoscopic liver resection for left lateral sectionectomy and partial hepatectomy for segment 5–6. In selected patients within the group and by experienced surgical team, the SILH technique results in comparable short-term surgical outcomes and long-term oncological outcomes.


Single-port Laparoendoscopic single site Liver resection Oncological outcome 



This manuscript was edited by Wallace Academic Editing.


This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards


Drs. Kuei-Yen Tsai, Hsin-An Chen, Wan-Yu Wang, and Ming-Te Huang have no conflicts of interest or financial ties to disclose.


  1. 1.
    Aldrighetti L, Guzzetti E, Pulitano C, Cipriani F, Catena M, Paganelli M, Ferla G (2010) Case-matched analysis of totally laparoscopic versus open liver resection for HCC: short and middle term results. J Surg Oncol 102:82–86CrossRefGoogle Scholar
  2. 2.
    Liu K, Chen Y, Wu X, Huang Z, Lin Z, Jiang J, Tan W, Zhang L (2017) Laparoscopic liver re-resection is feasible for patients with posthepatectomy hepatocellular carcinoma recurrence: a propensity score matching study. Surg Endosc 31:4790–4798CrossRefGoogle Scholar
  3. 3.
    Buell JF, Cherqui D, Geller DA, O’rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830CrossRefGoogle Scholar
  4. 4.
    Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’rourke N, Tanabe M, Koffron AJ (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261:619–629PubMedGoogle Scholar
  5. 5.
    Chuang S-H, Chen P-H, Chang C-M, Lin C-S (2013) Single-incision vs three-incision laparoscopic cholecystectomy for complicated and uncomplicated acute cholecystitis. World J Gastroenterol 19:7743CrossRefGoogle Scholar
  6. 6.
    Tan X, Wang G, Tang Y, Bai J, Tao K, Ye L (2017) Minilaparoscopic versus single incision cholecystectomy for the treatment of cholecystolithiasis: a meta-analysis and systematic review. BMC Surg 17:91CrossRefGoogle Scholar
  7. 7.
    Antoniou SA, Koch OO, Antoniou GA, Lasithiotakis K, Chalkiadakis GE, Pointner R, Granderath FA (2014) Meta-analysis of randomized trials on single-incision laparoscopic versus conventional laparoscopic appendectomy. Am J Surg 207:613–622CrossRefGoogle Scholar
  8. 8.
    Klaus A, Mühlmann G, Laimer E (2011) Single-incision laparoscopic surgery: Hernia repair. Asian J Endosc Surg 4:59–62CrossRefGoogle Scholar
  9. 9.
    Boone BA, Wagner P, Ganchuk E, Evans L, Evans S, Zeh HJ, Bartlett DL, Holtzman MP (2013) Single-incision laparoscopic splenectomy: preliminary experience in consecutive patients and comparison to standard laparoscopic splenectomy. Surg Endosc 27:587–592CrossRefGoogle Scholar
  10. 10.
    Ahn S-H, Son S-Y, Lee C-M, Jung DH, Park DJ, Kim H-H (2014) Intracorporeal uncut Roux-en-Y gastrojejunostomy reconstruction in pure single-incision laparoscopic distal gastrectomy for early gastric cancer: unaided stapling closure. J Am Coll Surg 218:e17–e21CrossRefGoogle Scholar
  11. 11.
    Katsuno G, Fukunaga M, Nagakari K, Yoshikawa S, Azuma D, Kohama S (2016) Short-term and long-term outcomes of single-incision versus multi-incision laparoscopic resection for colorectal cancer: a propensity-score-matched analysis of 214 cases. Surg Endosc 30:1317–1325CrossRefGoogle Scholar
  12. 12.
    Aldrighetti L, Ratti F, Catena M, Pulitanò C, Ferla F, Cipriani F, Ferla G (2012) Laparoendoscopic single site (LESS) surgery for left-lateral hepatic sectionectomy as an alternative to traditional laparoscopy: case-matched analysis from a single center. Surg Endosc 26:2016–2022CrossRefGoogle Scholar
  13. 13.
    Shetty GS, You YK, Choi HJ, Na GH, Hong TH, Kim D-G (2012) Extending the limitations of liver surgery: outcomes of initial human experience in a high-volume center performing single-port laparoscopic liver resection for hepatocellular carcinoma. Surg Endosc 26:1602–1608CrossRefGoogle Scholar
  14. 14.
    Han JH, You YK, Choi HJ, Hong TH, Kim DG (2018) Clinical advantages of single port laparoscopic hepatectomy. World J Gastroenterol 24:379CrossRefGoogle Scholar
  15. 15.
    Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205CrossRefGoogle Scholar
  16. 16.
    Tanaka S, Kubo S, Kanazawa A, Takeda Y, Hirokawa F, Nitta H, Nakajima T, Kaizu T, Kaneko H, Wakabayashi G (2017) Validation of a difficulty scoring system for laparoscopic liver resection: a multicenter analysis by the Endoscopic Liver Surgery Study Group in Japan. J Am Coll Surg 225(249–258):e241Google Scholar
  17. 17.
    Hu M, Zhao G, Wang F, Xu D, Liu R (2014) Single-port and multi-port laparoscopic left lateral liver sectionectomy for treating benign liver diseases: a prospective, randomized, controlled study. World J Surg 38:2668–2673CrossRefGoogle Scholar
  18. 18.
    Benzing C, Krenzien F, Atanasov G, Seehofer D, Sucher R, Zorron R, Pratschke J, Schmelzle M (2015) Single incision laparoscopic liver resection (SILL)–a systematic review. GMS Interdiscip Plast Reconstr Surg DGPW 4. CrossRefGoogle Scholar
  19. 19.
    Rao PP, Rao PP, Bhagwat S (2011) Single-incision laparoscopic surgery-current status and controversies. J Minim Access Surg 7:6PubMedPubMedCentralGoogle Scholar
  20. 20.
    Autorino R, White WM, Gettman MT, Khalifeh A, De Sio M, Lima E, Kaouk JH (2012) Public perception of “scarless” surgery: a critical analysis of the literature. Urology 80:495–502CrossRefGoogle Scholar
  21. 21.
    Kobayashi S, Nagano H, Marubashi S, Wada H, Eguchi H, Takeda Y, Tanemura M, Sekimoto M, Doki Y, Mori M (2010) A single-incision laparoscopic hepatectomy for hepatocellular carcinoma: initial experience in a Japanese patient. Minim Invasive Ther Allied Technol 19:367–371CrossRefGoogle Scholar
  22. 22.
    Aldrighetti L, Guzzetti E, Ferla G (2011) Laparoscopic hepatic left lateral sectionectomy using the LaparoEndoscopic Single Site approach: evolution of minimally invasive liver surgery. J Hepato-Biliary-Pancreat Sci 18:103–105CrossRefGoogle Scholar
  23. 23.
    Karabicak I, Karabulut K (2016) Single port laparoscopic liver surgery: a minireview. World J Gastrointest Endosc 8:444CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of General Surgery, Department of SurgeryTaipei Medical University Shuang Ho HospitalNew Taipei CityTaiwan
  2. 2.Division of General Surgery, Department of Surgery, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan

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