Ambulatory Surgery After Hepatectomy: Monitoring by Domomedicine Connected Tools and a Dedicated Nurse.

In response to public health expectations for the development of outpatient surgery, ministerial authorities are now encouraging medical facilities to organize their care around this innovative care pathway. Ambulatory surgery is gradually becoming one of the major objectives of any surgical service and many recommendations from the HAS (Haute Autorité de Santé) have recently become available to support and facilitate this transformation. Ambulatory surgery is no longer limited to "simple" surgery but also concerns highly technical surgical procedures with safety conditions identical to those required during conventional hospitalization. Therefore, ambulatory surgery must to limit the risk of postoperative complications but, in case of complications, to do everything possible to manage them quickly and not to make the patient lose chances because of his geographical distance. The main objective of this study is to evaluate the feasibility of a minor hepatectomy under laparoscopy during an ambulatory management. This management will be made possible thanks to the integration of Domomedicine and dedicated nursing care for a close and secure monitoring. The population is 20 major patients with an indication for laparoscopic surgery for peripheral benign or malignant liver tumor requiring liver resection of up to 2 segments. The study lasts a maximum of 15 months (12 months of inclusion, 1 month of patient follow-up and 1 month of prohibition from participating in another interventional study). The study will proceed as described below : • Initial diagnosis of the liver disease : Realization in primary care by a general practitioner (or gastroenterologist or oncologist) and realization of imaging in town

• Confirmation of diagnosis and registration: Surgical consultations and anesthesia consultation at the hospital and registration on the surgical staff list. (Pre-selection visit)
• Pre-operative evaluation (Inclusion visit): Consultation by the surgeon, and dedicated nurse.
• Surgical staff : Collegial evaluation of the surgical file, confirmation of the proposed surgical strategy.
• Preoperative follow-up : Home visit 3 working days before the intervention (Day -3) and telephone call 1 working day before the intervention (Day -1) Dedicated nurse consultation. Delivery of information and materials and information from stakeholders (Family caregivers, city IDE and attending physician)
• Hepatectomy (Day 0) : Outpatient intervention
• Postoperative follow-up =Day 1 to Day 7 + Visit Day 30 Call to Day 1 by the dedicated nurse Follow-up by dedicated nurse of the data transmitted during the 7 days following the hepatectomy coupled with home follow-up by the PRADO nurse, Co-Consultation (dedicated nurse and surgeon) on D7 and D30 (end of follow-up as part of the research).

Return of home medicine devices on Day 7 Report to attending physician.

The expected benefits for the patient are:

• Limitation of infections associated with care (nosocomial)
• Habits, rhythm of life and family and social environment preserved thanks to the return home the same day
• Potentially faster return to work
• Reduction in the cost of hospitalization he expected benefits for the company:
• Optimization of the organization and resources of surgical technical platforms
• Decongestion of hospitalization services
• Sustainability of the health system thanks to shorter stays and therefore less expensive for the Health Insurance
• Implementation of innovative protocols, publications and potential notoriety. The risks of the study are low, the use of the platform will not replace existing uses, but will provide new or additional information whose consistency is verified by the care team. Post-operative follow-up will be equivalent in terms of the frequency of paramedical visits to conventional care (hospitalization > 1 day) and a doctor will be contactable by the dedicated nurse 24 hours a day to organize, if necessary, a transfer to the emergency room or the Hepato-Biliary Center of the Paul Brousse Hospital.

The use of the connected devices does not involve any specific risk because they are non-invasive sensors marketed and marked CE. Regarding the postoperative risk of severe complications (severe bleeding or severe sepsis), this is low, even very low (<0.5%) since we will only include minor hepatectomies. In addition, cirrhotic patients will not be included in this study.