Ahmad Mahamid, Yaniv Fenig, Salvatore Amodeo, Lucas Facciuto, Dagny Vonahrens, Omri Sulimani, Thomas Schiano, Marcelo Facciuto

Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, United States


Objective: Optimal incision for major hepatectomy remains controversial. In this study, we described our experience with a limited upper midline incision (UMI) for major hepatectomy. The objective was to analyze the feasibility and safety of UMI in major hepatectomy.

Material and Methods: Fifty-seven consecutive patients who underwent major hepatectomies performed via an UMI were compared to a control group of 36 patients who underwent major hepatectomies with a conventional incision (CI).

Results: In 85% of the patients, the indication was malignancy, with a median tumor size of 6 cm. Fifty-three percent of the patients had underlying chronic liver disease, and liver fibrosis was found in 61% of the patients. Ninteen percent of the patients had previous upper abdominal surgery. Twenty- six patients underwent left hepatectomy, 20 patients had right hepatectomy and 11 patients trisegmentectomy. Additional combined surgical proce- dures were performed in 42% of the patients. Median operative time was 323 minutes, estimated blood loss was 500 ml, and median post-operative hospital stay was seven days. Surgical complications occurred in 22 patients (39%). 5-year overall survival was 67%. When compared with the control group with CI, patients with UMI had no statistical difference on operative time, estimated blood loss, length of hospital stay, complication rate, and overall survival.

Conclusion: Major hepatectomies can be safely performed through UMI. This approach should be considered as a reasonable option in addition to conventional and laparoscopic approaches for major hepatectomies.

Keywords: Upper midline incision, right hepatectomy, left hepatectomy, trisegmentectomy, major hepatectomy


Ethics Committee Approval

Thi study approval was obtained from Institutional Board of the Mount Sinai School of Medicine (Project Information: HS#:20-00917, Date: 31.07.2020).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - All of authors; Design - All of authors; Supervision - All of authors; Data Collection and/or Processing - All of authors; Analysis and/or Interpretation - All of authors; Literature Search- All of authors; Writing Manuscript - All of authors; Critical Reviews - All of authors.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.