Comparison of transumbilical single-port and conventional multi-port laparoscopic hepatectomy for benign liver lesions

Abstract

Transumbilical single-port laparoscopic hepatectomy represents a further refinement of minimally invasive liver surgery, but its safety and perioperative value remain insufficiently defined. This study aimed to compare transumbilical single-port laparoscopic hepatectomy with conventional multi-port laparoscopic hepatectomy for selected benign liver lesions. We retrospectively analyzed 80 patients who underwent laparoscopic hepatectomy at The Affiliated Hospital of Qingdao University between February 2022 and February 2025. Among 352 consecutive patients screened, 80 met the predefined eligibility criteria and were retrospectively classified according to the surgical approach actually performed, with 40 patients in each group; no matching or deliberate control selection was performed. Baseline characteristics, lesion type, surgical procedure, ECOG performance status, and perioperative outcomes were compared. Primary outcomes included operative time, intraoperative blood loss, postoperative bowel recovery time, postoperative hospital stay, and major postoperative complications. Standardized mean differences were used to assess baseline balance, and multivariable linear regression was performed to adjust for potential confounders. Baseline characteristics were generally comparable between the two groups. All patients successfully completed laparoscopic hepatectomy without unplanned additional trocar placement or conversion to open surgery. Compared with the multi-port group, the single-port group had a significantly longer operative time (163.25 ± 57.15 vs. 117.00 ± 42.17 min; P < 0.001) but a significantly shorter postoperative bowel recovery time (median [interquartile range], 2.00 [1.75–2.00] vs. 3.00 [2.00–3.00] days; P < 0.001). No significant differences were observed in intraoperative blood loss or postoperative hospital stay. No bile leakage, intra-abdominal infection, or postoperative major hemorrhage occurred in either group. After adjustment for age, sex, comorbidity history, lesion type, surgical procedure, and ECOG status, single-port surgery remained independently associated with prolonged operative time and faster bowel recovery. Transumbilical single-port laparoscopic hepatectomy is safe and feasible for carefully selected patients with benign liver lesions. Although it requires a longer operative time, it was not associated with greater blood loss, longer postoperative hospital stay, or a higher observed rate of major complications in this selected cohort and may promote earlier bowel function recovery.