Assessment of surgical invasiveness in hepatobiliary and pancreatic surgeries by quantifying intraoperative energy expenditure: A comparison between laparoscopic and open surgery.

OBJECTIVE

This study aimed to quantify surgical energy expenditure (SEE, kcal) during hepatobiliary and pancreatic surgery and to investigate its relationship with surgical outcomes.

METHODS

SEE was calculated for 185 hepatic or pancreatic resections using Weir's equation, based on intraoperative oxygen consumption and carbon dioxide production. Postoperative outcomes and SEE differences between surgical procedures, particularly between open and minimally invasive surgery (MIS), were analyzed.

RESULTS

SEE significantly differed among procedures, including partial/segmental hepatectomy, pancreaticoduodenectomy (PD), and distal pancreatectomy. SEE was primarily dependent on operative time and also correlated with blood loss. From the SEE perspective, open surgery had the advantage of shorter duration but greater blood loss, whereas MIS demonstrated the opposite trend. Higher SEE was a significant risk factor for postoperative complications. Among comparable procedures, laparoscopic PD showed significantly lower SEE per unit time than open PD.

CONCLUSION

SEE is a quantifiable and objective indicator of surgical invasiveness in HBP surgery. MIS reduces per-unit-time burden by limiting blood loss, but prolonged operative time may offset this benefit. Improving both operative efficiency and blood loss control is essential for MIS to achieve true minimal invasiveness.