Article Abstract

Observing an upward trajectory in minimally invasive hepatectomies in Singapore—a nationwide analysis

Authors: Chun Han Nigel Tan, Kah Hwee Jarrod Tan, Chin Li Lee, Lip Seng Lee, Kah Heng Adrian Chiow, Brian K. P. Goh, Ser Yee Lee, Chung Yip Chan, Iyer Shridhar Ganpathi, Wei Chieh Alfred Kow

Abstract

Background: Minimally invasive hepatectomies (MIH) are being increasingly performed globally for both benign and malignant disease. The benefits of a minimally invasive approach for hepatectomies are undisputed, with recent data suggesting comparable long-term outcomes compared to open resections. Since the first MIH in Singapore in 2004, we have seen the widespread adoption of MIH. In this study, we analyze the trends of MIH across all major institutions in Singapore.
Methods: A retrospective review of all cases of MIH performed across four institutions were analyzed. Demographic, clinical and operative data was collected and analyzed.
Results: A total of 718 cases were performed since 2004. There was a yearly increase in the number of MIH with an inflection point in 2012. In addition, there was an increasing number of major MIH resections and an increasing proportion of major to minor resections over the years. The most common approach to MIH was a completely laparoscopic approach (n=626, 87.1%), followed by a robotic approach (n=48, 6.7%) and subsequently hand assisted (n=23, 3.2%) and lap assisted (n=21, 2.9%) approaches. The most common indication for surgery was hepatocellular carcinoma (HCC) (n=393, 54.7%). The overall conversion rate was 9.6% (n=69).
Conclusions: Centers in Singapore are performing an increasing number of MIH over the years with an increasing number of major MIH and complex resections. We expect that MIH will soon be adopted as the standard of care for liver resections in Singapore.