Abstract
Background: Interest in MILS is increasing,showing significant postoperative advantages for patients Methods: A single Surgeon with advanced expertise in both open HBP surgery as well as in advanced laparoscopic GI surgery,started a development program for introducing MILS at a large tertiary referral institution in northern Italy, in 2006.In 10 years activity 129 patients underwent laparoscopic liver resection. Results: Preoperative diagnosis was CLM in 33,5%, HCC in 15.5%, IHCC+CCC in 7%, Non-Colorectal Liver Metastases in 2%,Benign Lesions in 42%.Median operation time was 154 min.Transfusion were necessary in 10%. Liver-specific conversion rate 18.6%. Most common procedures were Single wedge(29.5%), Segmentectomy(16.3%), Left lateral sectionectomy(21.7%).Major complication (Clavien-Dindo>= 3) rate was 10% and median LOS was 5 days.Mortality occurred in none. Conclusion: TECHNICAL TIPS& RICKS (Educational Video):Intraoperative ultrasound was performed to confirm the number and location of hepatic lesions as well as their proximity to portal pedicles and hepatic veins. Liver parenchyma was transected using ultrasonic scalpel with need of #2 Pringle maneuvers (duration 20 min each-20 min off). Parenchymal transection with ultrasonic scalpel was undertaken following the US-guided demarcation line. Branches of bile ducts, portal and hepatic veins,were controlled by Hem-o-lok clips or single stitches. Trisegmentectomy (IVbs-Vs-VIs) was performed.Patients are managed post-operatively according to ERAS institutional protocol
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