A review of 125 cases of laparoscopic right- and left-hepatectomy in Cleveland clinic

Abstract

Presenter: Federico Aucejo MD | Cleveland Clinic Foundation Background: The early series of laparoscopic liver resections (LLR) were often non-anatomic minor resections, but recent surgical/instrumental advantages enable surgeons to apply LLR to anatomical major resection. Although major LLR has been established in some Asian/European experienced centers, the pure major LLR is still not widely accepted in the US. In our institute, we gradually increased the number of LLR and we have been trying to achieve similar quality and safety with major LLR as with open hepatectomy. The aim of this study was to introduce our institute’s series of laparoscopic right- and left- hepatectomy. Methods: This study included patients who underwent formal hemi-hepatectomy using laparoscopic approach between 1/2008-1/2021. Chronological trends in surgical approach and patient outcomes were assessed. Results: During the study period, 125 patients underwent formal hemi-hepatectomy using laparoscopic approach including hand-assisted approach. The median patient age was 52 years old (range: 20-87) and most of patients were male (69/125, 55.2%). The median body mass index was 27.5 (range: 18.9-39.9). The indication for surgery was as follows: 19 benign tumor, 67 malignant tumor, and 39 live donor. The breakdown of malignant tumor was as follows: colorectal metastases: 27, hepatocellular carcinoma: 16, intrahepatic cholangiocarcinoma: 15, neuroendocrine metastases: 2, others: 7. The trend in case numbers during the study period is shown in Figure A. The case number increased after 2017 and most of the cases were completed after 2017 (101 cases: 80.8 %). Of the 125, 62 patients underwent right hepatectomy (pure-laparoscopic: 53, hand-assisted: 9, converted to open: 13, Figure B) and 63 patients underwent left hepatectomy (pure-laparoscopic: 59, hand-assisted: 4, converted to open: 4, Figure C). The use of hand-assisted approach decreased significantly over time. Open conversion also significantly decreased after revising surgical procedures and instruments in 2018. The median operative time was 434 minutes in right hepatectomy and 360 minutes in left hepatectomy, respectively (Figure D). The Post-operative complications (Clavian-Dindo grade ≥2) was seen in 25 patients (16 in right and 9 in left). Postoperative mortality was seen in one patient who underwent right hepatectomy. Conclusion: Pure-laparoscopic hemi-hepatectomy is now established as standard procedure in our institute. The chronological technical and instrumental refinement in our institute, as well as current our standardized right and left videos will be presented.