Single-port versus multi-port laparoscopic left lateral sectionectomy using articulating instruments: a comparative study

Single-port laparoscopic surgery (SPLS) for left lateral sectionectomy (LLS) offers potential advantages in reducing invasiveness and improving cosmesis, but its adoption remains limited because of technical challenges, including loss of triangulation and instrument collision. We hypothesized that using articulating instruments could overcome these limitations and allow SPLS to achieve outcomes equivalent to conventional multi-port laparoscopic surgery (MPLS). A retrospective cohort of 77 patients undergoing LLS was analyzed (SPLS, n = 42; MPLS, n = 35). SPLS was performed via a single umbilical incision using articulating instruments. Perioperative outcomes were compared. Baseline demographics and tumor characteristics were similar. All procedures were completed laparoscopically without conversion to open surgery or additional port placement. No significant differences were found in operative time, estimated blood loss, R0 resection rate (100% in both), or postoperative complication rates (SPLS 2.4% vs. MPLS 5.7%). No patient in the SPLS group required a blood transfusion, compared to two patients (5.7%) in the MPLS group (p > 0.05). The SPLS group had a significantly shorter hospital stay (5 vs. 6 days, p = 0.02). No mortality, reoperation, or port-site complication occurred. In selected patients and in the hands of experienced surgeons, SPLS using articulating instruments is a safe and effective alternative to conventional multi-port laparoscopy, achieving comparable perioperative and oncologic outcomes with a shorter postoperative hospital stay. These findings support articulating instrument-assisted SPLS as a feasible and high-quality approach for minor liver resection in experienced centers.