Laparoscopic Liver Resection Research Articles

Comparative evaluation of the learning curve of laparoscopic liver resection after self-training and during the mentoring program

Comparative evaluation of the learning curve of laparoscopic liver resection after self-training and during the mentoring program

Safety and efficacy of laparoscopic liver resection in patients with underlying liver disease

Safety and efficacy of laparoscopic liver resection in patients with underlying liver disease

Anatomical laparoscopic liver resection by fluorescence positive staining technique using a novel instrument, “Laparo-Probe Guide”

Anatomical laparoscopic liver resection by fluorescence positive staining technique using a novel instrument, “Laparo-Probe Guide”

Right kidney position for laparoscopic liver resection of tumors located in the posterosuperior region

Right kidney position for laparoscopic liver resection of tumors located in the posterosuperior region

Laparoscopic liver resection involving segment 7: 10-year single center experience

Laparoscopic liver resection involving segment 7: 10-year single center experience

Hypotension during laparoscopic liver resection impact on complications including kidney injury

Hypotension during laparoscopic liver resection impact on complications including kidney injury

Safety and feasibility of Laparoscopic liver resection in hepatocellular carcinoma with bile duct tumour thrombus: A single-centre case series

Safety and feasibility of Laparoscopic liver resection in hepatocellular carcinoma with bile duct tumour thrombus: A single-centre case series

Robotic versus laparoscopic liver resection in various settings: an international multicenter propensity score-matched study of 10,075 patients

Robotic versus laparoscopic liver resection in various settings: an international multicenter propensity score-matched study of 10,075 patients

Laparoscopic liver resection for hepatocellular carcinoma in patients with and without portal hypertension: a case-control study

Laparoscopic liver resection for hepatocellular carcinoma in patients with and without portal hypertension: a case-control study

Minimally invasive liver resection for cholangiolocellular carcinoma: A single‐institution experience

AbstractIntroductionCholangiolocellular carcinoma (CoCC) resembles cholangiocellular carcinoma (CCC) and presents a variety of imaging findings; thus, preoperative diagnosis is often difficult.MethodsWe retrospectively studied patients who were diagnosed with CoCC at the Kansai Rosai Hospital from 2006 to 2021 and treated by laparoscopic liver resection (LLR) or open liver resection (OLR).ResultAmong 918 liver resections, 15 patients were diagnosed with CoCC: 11 underwent LLR and 4 OLR. For LLR and OLR, respectively, patient age was 69.9 ± 6.8 and 72.8 ± 10.6, sex was M/F: 10/1 and 2/2, Child‐Pugh was A/B/C: 10/1/0 and 4/0/0, liver damage was A/B/C: 8/3/0 and 4/0/0, preoperative diagnosis was CoCC/CCC/HCC: 1/2/8 and 2/2/0, pathological stage of Union for International Cancer Control (UICC) was IA/IB/II/IIIA/IIIB/IV: 8/0/2/1/0/0 and 0/0/3/0/1/0 (p = .0312), and extent of liver resection was Hr0/HrS/Hr1/Hr2/: 3/0/5/3 and 1/1/0/2. In LLR and OLR, respectively, operation time was 417.5 ± 191.0 and 407.5 ± 187.9 min, blood loss was 123.3 ± 217.4 and 1385.0 ± 1038.7 mL, and postoperative hospital stay was 12.2 ± 13.7 and 15.0 ± 6.6 days. For stages I and II/III, respectively, the 5‐year disease‐free survival rates were 100.0% and 34.3%, and the 5‐year overall survival rates were 100.0% and 55.6%. For stage II/III LLR and OLR, respectively, the 3‐year disease‐free survival rates were 33.3% and 37.5% (p = .8418), and the 5‐year overall survival rates were 66.7% and 50.0% (p = .8084).ConclusionAlthough further studies are still needed to confirm, minimally invasive liver resection without lymph node dissection is one of a safe and effective approach to the management of CoCC.

A commentary on 'approaches of laparoscopic anatomical liver resection of segment 8 for hepatocellular carcinoma: a retrospective cohort study of short-term results at multiple centers in China'.

A commentary on 'approaches of laparoscopic anatomical liver resection of segment 8 for hepatocellular carcinoma: a retrospective cohort study of short-term results at multiple centers in China'.

ASO Author Reflections: Cirrhosis and Severity of Cirrhosis Negatively Affects the Outcomes of Laparoscopic and Robotic Major Liver Resections for Primary Liver Malignancies.

ASO Author Reflections: Cirrhosis and Severity of Cirrhosis Negatively Affects the Outcomes of Laparoscopic and Robotic Major Liver Resections for Primary Liver Malignancies.

Evolution of laparoscopic liver resection in the last two decades: lessons from 2000 cases at a referral Korean center.

Laparoscopic liver resection (LLR) has evolved to become the standard surgical approach in many referral centers worldwide. The aim of this study was to analyze how LLR evolved at a single high-volume referral center since its introduction, more than two decades ago. Data from all consecutive LLR between January 2003 and September 2022 at the Seoul National University Bundang Hospital were analyzed. Perioperative outcomes were compared between three time periods, with major technological innovations considered as landmarks: before introduction of laparoscopic-US and CUSA (2003-2006), before (2006-2015) and after (2015-2022) introduction of high-definition scope. During the analyzed time periods the number of technically challenging procedures increased from 39.2 to 61.1% (p < 0.001). The most recent period showed shorter median operation time (from 267.5' to 175', p < 0.001), lower median estimated blood loss (EBL) (from 500 to 300ml, p < 0.001), lower intraoperative transfusions (from 33.8 to 9.3%, p < 0.001), shorter median postoperative hospital stay (from 12 to 6days, p < 0.001). The time period, a technical major resection and an underlying liver cirrhosis were found to be the associated with longer operation time (p < 0.001) in the multivariable linear regression analysis, while tumor size, technically major surgeries and liver cirrhosis were associated with higher EBL (p < 0.001). During the last two decades, the indications for patients undergoing LLR have expanded significantly, including more and more challenging procedures and frail patients. Despite such challenges, perioperative outcomes improved, although technically major procedures, cirrhotic patients and huge tumors have still to be considered challenging situations.

Comparison of clinical outcome between laparoscopic and open hepatectomy of high difficulty score for hepatocellular carcinoma: a propensity score analysis.

Laparoscopic liver resection (LLR) of high difficulty score is technically challenging. There is a lack of clinical evidence to support its applicability in terms of the long-term survival benefits. This study aims to compare clinical outcomes between LLR and the open liver resection of high difficulty score for hepatocellular carcinoma (HCC). From 2010 to 2020, using Iwate criteria, 424 patients underwent liver resection of high difficulty score by the laparoscopic (n = 65) or open (n = 359) approach. Propensity score (PS) matching was performed between the two groups. Short-term and long-term outcomes were compared between PS-matched groups. Univariate and multivariate analyses were performed to identify prognostic factors affecting survival. The laparoscopic group had significantly fewer severe complications (3% vs. 10.8%), and shorter median hospital stays (6days vs. 8days) than the open group. Meanwhile, the long-term oncological outcomes were comparable between the two groups, in terms of the tumor recurrence rate (40% vs. 46.1%), the 5-year overall survival rate (75.4% vs. 76.2%), and the 5-year recurrence-free survival rate (50.3% vs. 53.5%). The high preoperative serum alpha-fetoprotein level, multiple tumors, and severe postoperative complications were the independent poor prognostic factors associated with worse overall survival. The surgical approach (Laparoscopic vs. Open) did not influence the survival. LLR of high difficulty score for selected patients with HCC has better short-term outcomes than the open approach. More importantly, it can achieve similar long-term survival outcomes as the open approach.

Risk factor analysis of conversion in laparoscopic liver resection for intrahepatic cholangiocarcinoma.

The risk factors of patients with intrahepatic cholangiocarcinoma (ICC) requiring conversion to open surgery have not been adequately studied. This study aimed to determine the risk factors and postoperative outcomes of conversion in patients with ICC. From May 2014 to September 2022, Unplanned conversions were compared with successful LLRs. 153 patients with ICC initially underwent LLR, of which 41 (26.8%) required conversion to open surgery. Multivariate analysis for those factors that were statistically significant or confirmed by clinical studies, tumor proximity to the major vessels (OR 6.643, P < 0.001), and previous upper abdominal surgery (OR 3.140, P = 0.040) were independent predictors of unplanned conversions. Compared to successful LLRs, unplanned conversions showed longer operative times (300.0 vs. 225.0min, P < 0.001), more blood loss (500.0 vs. 200.0mL, P < 0.001), higher transfusion rates (46.3% vs. 11.6%, P < 0.001), longer length of stays (13.0 vs. 8.0days, P < 0.001), and higher rates of major morbidity (39.0% vs. 11.6%, P < 0.001). However, there was no statistically significant difference in 30-day or 90-day mortality between the conversion group and the laparoscopic group. Conversion during LLR should be anticipated in ICC patients with prior upper abdominal surgery or tumor proximity to major vessels as features.

Inflow control can be safely used in laparoscopic subsegmentectomy of the liver: a single-center 10-year experience

BackgroundSeveral techniques have been developed to reduce blood loss in liver resection. The half-Pringle and Pringle maneuvers are commonly used for inflow control. This study compared the outcomes of different inflow control techniques in laparoscopic subsegmentectomy.MethodsFrom October 2010 to December 2020, a total of 362 laparoscopic liver resections were performed by a single surgeon (C.C. Yong) in our institute. We retrospectively enrolled 133 patients who underwent laparoscopic subsegmentectomy during the same period. Perioperative and long-term outcomes were analyzed.ResultsThe 133 patients were divided into 3 groups: no inflow control (n = 49), half-Pringle maneuver (n = 46), and Pringle maneuver (n = 38). A lower proportion of patients with cirrhosis were included in the half-Pringle maneuver group (P = .02). Fewer patients in the half-Pringle maneuver group had undergone previous abdominal (P = .01) or liver (P = .02) surgery. The no inflow control group had more patients with tumors located in the anterolateral segments (P = .001). The no inflow control group had a shorter operation time (P < .001) and less blood loss (P = .03). The need for blood transfusion, morbidity, and hospital days did not differ among the 3 groups. The overall survival did not significantly differ among the 3 groups (P = .89).ConclusionsThe half-Pringle and Pringle maneuvers did not affect perioperative or long-term outcomes during laparoscopic subsegmentectomy. The inflow control maneuvers could be safely performed in laparoscopic subsegmentectomy.

Resecciones hepáticas videolaparoscópicas: estudio descriptivo de nuestra experiencia en 16 años

Background: Improvements in laparoscopic surgery have led to more rapid progress in laparoscopic liver resections. The indications of this approach are still matter of debate. Objectives: The aim of the present study is to describe the results obtained in series of patients undergoing laparoscopic liver resections. Material and methods: We conducted a descriptive, observational and analytical study. We evaluated a series of patients undergoing laparoscopic liver resection categorized by Iwate criteria between January 2005 and October 2021. The demographic variables, diagnosis, type of approach, intraoperative findings, clinical and technical aspects and complications, were analyzed. Results: Of 159 patients undergoing hepatectomies, 120 procedures were performed laparoscopically (applicability rate 75%) and were divided into four groups according to the Iwate scoring system: low (difficulty index 0–3), 23 patients (19%); intermediate (difficulty index 4–6), 48 patients (40%); advanced (difficulty index 7–9), 33 patients (28%); and expert (difficulty index 10–12). 16 patients (13%). Median age was 62 years. The rate of Clavien-Dindo complications ≥ grade 3 was 14.28% and mortality rate was 2.5%. In resections of colorectal liver metastases disease-free survival was 75%, 59%, 46% at 1, 3 and 5 years, respectively, and overall survival was 93%, 79% and 69%, at 1, 3 and 5 years, respectively. Conclusions: Laparoscopic liver resection resulted a feasible and safe technique and should be performed by trained surgeons, in specialized centers and with long learning curves to increase the applicability rate from the simplest resections to the most complex ones. Careful selection of patients is required to ensure their safety.

Editorial acerca de: “Resecciones hepáticas videolaparoscópicas: estudio descriptivo de nuestra experiencia en 16 años”

Laparoscopic liver resections (LLRs) are steadily evolving. Any liver resection can be performed laparoscopically, depending on the experience of the surgical team and the hospital environment in which the practice is performed. There is scientific evidence that LLRs has better surgical outcomes than conventional hepatectomies, and the oncological results are noninferior1-3. The study presented by Alesandrini A et al. shows the experience of a pioneering team in our country in minimally invasive liver surgery4. One of the most significant findings is the 75% applicability rate of the method. This percentage is really very high and is one of the highest in our region. We must keep in mind that these results cover the initial stage of their experience. According to a publication by J. Pekolj some years ago, reviewing the experience in South America, the average applicability rate of LLRs in the region ranges from 4 to 85%5.

A safe and simple exposure and Pringle maneuver in laparoscopic anatomical liver resection of segment 7

BackgroundLaparoscopic access to liver segment 7 (S7) is difficult for deep surgical situations and bleeding control. Herein, our proposed laparoscopic technique for S7 lesions using a self-designed tube method is introduced.MethodsClinical data of patients who underwent laparoscopic anatomical liver resection of S7 (LALR-S7) with the help of our self-designed tube to improve the exposure of S7 and bleeding control in the Second Affiliated Hospital, Third Military Medical University (Army Medical University) from April 2019 to December 2021 were retrospectively analyzed to evaluate feasibility and safety.ResultsNineteen patients were retrospectively reviewed. The mean age was 51.3 ± 10.3 years; mean operation time, 194.5 ± 22.7 min; median blood loss, 160.0 ml (150.0–205.0 ml); and median length of hospital stay, 8.0 days (7.0–9.0 days). There was no case conversion to open surgery. Postoperative pathology revealed all cases of hepatocellular carcinoma (HCC). Free surgical margins were achieved in all patients. No major postoperative complications were observed. Patients with postoperative complications recovered after conservative treatment. During outpatient follow-up examination, no other abnormality was presented. All patients survived without tumor recurrence.ConclusionsThe preliminary clinical effect of our method was safe, reproducible and effective for LALR-S7. Further research is needed due to some limitations of this study.

Robotic versus laparoscopic liver resection for liver malignancy: a systematic review and meta-analysis of propensity score-matched studies.

How different surgical procedures, including the robotic-assisted liver resection (RLR) and laparoscopic liver resection (LLR), can affect the prognosis of patients with liver malignancies is unclear. Thus, in this study, we compared the effects of RLR and LLR on the surgical and oncological outcomes in patients with liver malignancies through propensity score-matched cohort studies. The PubMed, Embase, and Cochrane databases were searched using Medical Subject Headings terms and keywords from inception until May 31, 2023. The quality of the included studies was assessed using the Newcastle-Ottawa quality assessment scale. The mean difference with 95% confidence interval (95% CI) was used for analysis of continuous variables; the risk ratio with 95% CI was used for dichotomous variables; and the hazard ratio with 95% CI was used for survival-related variables. Meta-analysis was performed using a random-effects model. Five high-quality cohort studies with 986 patients were included (370 and 616 cases for RLR and LLR, respectively). In terms of surgical outcomes, there were no significant differences in the operation time, conversion rate to open surgery, overall complication rate, major complication rate, and length of hospital stay between the RLR and LLR groups. In terms of oncological outcomes, there were no significant differences in the 5-year overall survival and disease-free survival between the two groups. Surgical and oncological outcomes are comparable between RLR and LLR on patients with liver malignancies. Therefore, the benefits of applying RLR in patients with liver malignancies need to be further explored.