Outcomes Of Laparoscopic Liver Resection Research Articles

Outcomes of Laparoscopic Liver Resection for Lesions Located in the Right Side of the Liver

Laparoscopic right-sided liver resection may be feasible and safe. Retrospective analysis. Department of surgery at a university hospital. Of 103 consecutive laparoscopic liver resections performed from May 1, 2003, to April 30, 2007, 46 patients underwent a right-sided laparoscopic liver resection. Six operations required conversion (13%) to open surgery. Overall, data from 40 patients with benign liver tumors (n = 2), intrahepatic duct stones (n = 3), liver metastasis from colorectal cancer (n = 8), and hepatocellular carcinomas (n = 27) were analyzed. Feasibility and operative outcome. The operations included 12 major resections (5 right hemihepatectomy and 7 right posterior sectionectomy) and 28 minor resections (14 segmentectomy and 14 tumorectomy). No operative mortality, subsequent operation, or life-threatening complications occurred. Overall, 11 patients (28%) experienced complications; 2 had bile leakage, 6 had perihepatic fluid collection, 2 had prolonged ascites, and 1 had pleural effusion. All recovered after conservative management. The mean operation time was 300 minutes, the mean blood loss was 620 mL, and the mean hospital stay was 11 days. For lesions located at segment VII or VIII (n = 15), the mean operation time and amount of blood loss in those receiving a minor liver resection were similar to those who received a major resection (P = .21 and .88, respectively). Although greater technical refinement is required for a minor resection in the superior part of the right side of the liver, laparoscopic right-sided liver resection is feasible and safe.

Results of laparoscopic liver resection: retrospective study of 68 patients

Although an increasing number of reports and publications have dealt with the laparoscopic approach to liver resection, this procedure remains uncommon, and its feasibility, safety and effectiveness are still not established. There are few reports of the advantages of this approach on postoperative recovery. From December 1997 to March 2007, laparoscopic hepatic resection were performed in 68 patients. There were 52 malignant tumors (36 hepatocellular carcinomas, three intrahepatic cholangiocarcinomas, one cystadenocarcinoma, liver metastases from ten colorectal carcinomas and two other organs) and 16 benign lesions among our 68 patients. Fifteen patients with hepatocellular carcinoma had cirrhosis. The mean tumor size was 3.1 +/- 1.8 cm (range 1.0-14.0 cm), and the tumors were located in every liver segment except segment I. Liver resection was anatomical in 17 patients and consisted of a lobectomy in four patients and a lateral segmentectomy in 13 patients. Non-anatomical resections were performed in 51 patients. The operative time was 214 +/- 93 min. Mean blood loss was 393 +/- 564 g. A hand-assisted laparoscopic method or mini-laparotomy method was required in 35 patients (51.4%). Operative complications occurred mainly in our early cases and included three patients (4.4%) with operative bleeding, 2 of whom (2.9%) requiring a conversion to open surgery. Postoperative complications occurred in seven patients (10.0%), and two of then eventually required a re-operation. The mean hospital stay was 17 days. There were no complications in the more recent cases. The laparoscopic approach for liver tumors is feasible, if the indication is carefully selected. The safety of this procedure depends on the surgical experience of the surgeon and team and the availability of the necessary technology.

Initial experience in laparoscopic liver resection of benign solid and cystic lesions

Objective To analyze technical feasibility and evaluate outcome of laparoscopic liver resection of benign solid and cystic lesions.Methods Between April 2005 and December 2006,15 patients underwent laparoscopic liver surgery in our hospital.There were two groups of benign lesions:cysts(n=9)and solid tumors(n=6),including solitary giant liver cysts(n=4),multiple simple cysts (n=4),polycystic liver disease(n=1),hemangioma(n=3),focal nodular hyperplasia(n=1),tuberculoma(n=1),and lipoma(n=1).Results The procedures were completed laparoscopically in all patients.Mean size was 13(7-27)cm for liver cysts and 4.3(2.5-7)cm for solid nodules.There was no Conversion to laparotomy.No transfusion occurred.The mean operative time was 88 min.There were no complications after resection of solid tumors.The median length of hospital stay was 4 d.Conclusion Laparoscopic liver surgery can be accomplished safely in selected patients with benign tumors.The technical aspects and devices of laparoscopic liver surgery have evolved rapidly and resulted in a shift in the therapeutic approach to benign liver tumors. Key words: Liver neoplasms; Laparoscopy; Resection

Laparoscopic liver resection: preliminary results from a UK centre

Advancements in surgical technique and technology have facilitated safe laparoscopic liver resection in selected patients. The aim of this study is to evaluate the feasibility and outcome of laparoscopic liver resection. Patients with lesions situated in the anterior and left lateral segments were selected for laparoscopic resection. Data were collected prospectively. Between 2003 and 2007, 24 patients (12 males) with a median (range) age of 65 (30-83) years underwent 24 laparoscopic hepatic resections for presumed colorectal metastases (n=20) and other indications (n=4). The resections included left hepatic lobectomy (n=14), other resections of two or three segments with or without metastasectomy (n=5), left hemihepatectomy (n=2) and unisegmentectomy (n=3). All procedures were completed laparoscopically. Median operating time was 155 min. Estimated median (range) blood loss was 100 (25-1100) ml and one patient received two units blood transfusion. The operative morbidity rate was 4%, and there were no operative deaths. The median (range) postoperative hospital stay was 3 (1-14) days. At median (range) follow-up of 13.5 (5-36) months, 4 patients (21%) had disease recurrence and 17 patients (89%) remained alive. In selected patients with lesions in the anterior and left lateral segments, laparoscopic liver resection is feasible, achieves adequate cancer resection and is associated with smooth and rapid recovery. Long-term follow-up data are required for oncological results.

Comparison between staple and vessel sealing device for parynchemal transection in laparoscopic liver surgery in a swine model

Background. Advancements in technology have allowed laparoscopic surgery to expand into advanced procedures such as liver resection; however, the transection method is debatable. This study was designed to evaluate the feasibility and outcome of laparoscopic liver resection comparing the vessel sealing device (VSD) versus endomechanical stapling devices for parenchymal transection in a swine model. Materials and methods. Laparoscopic left hepatectomy was performed in two groups (n=7 in each group) comparing the stapler device with the VSD. The cut surfaces of the liver were evaluated for bleeding and biliary leakage at the time of the operation and 1 week later. The animals were sacrificed 1 week after the operation to determine hemorrhage and bile leakage, and to allow histological evaluation of the liver. Serum liver enzymes were checked before, after, and 1 week postoperatively. Results. No evidence of biliary leakage or hemorrhage was noted at the time of the operation and 1 week later for both groups. There was a trend toward an increase in blood loss in the stapled group compared with LigaSure (40±16.4cc vs 17±3.7cc, p>0.05). There was also a trend toward shorter transection time in the stapled group compared with the LigaSure group (15±4.1min vs 21.8±5.3, p>0.05). The instrument cost was significantly higher in the stapled group (720±110 vs 400±50; p<0.05). There was no difference in serial liver enzymes and liver histopathology in the two groups. Conclusions. The VSD and endomechanical stapler can be safely and effectively used for parenchymal transection during laparoscopic liver resection. However, using endomechanical staplers is associated with an increase in cost.

Laparoscopic hepatic resection for hepatocellular carcinoma: Retrospective study of 12 patients

To assess the results of laparoscopic liver resection for hepatocellular carcinoma. From 1998 to 2003, 12 laparoscopic liver resections for hepatocellular carcinoma were performed. There were no operative complications and no deaths. Conversion to laparotomy was required in one patient (8%) and transfusion in three patients (25%). One patient died of liver failure. Postoperative complications occurred in three patients (25%): trocar site bleeding, cardiac failure and biliary collection. The mean hospital stay was 5 days. No ascites and no transient liver failure occurred. During the mean follow up of 15 months the recurrence rate was 45.5%. No port site or peritoneal metastases were observed. Treatment of recurrence was second resection in two patients and microwave coagulation therapy in two other patients. Mean survival was 24 months. Laparoscopic liver resection is feasible in hepatocellular carcinoma if the tumor is unique, smaller than 5 centimeters and located in the left lateral segments or in the anterior or inferior segments of the right liver. Postoperative morbidity is low and long-term results seem to be similar to laparotomy.

Laparoscopic liver resection of benign liver tumors.

The objective of this study was to assess the feasibility, safety, and outcome of laparoscopic liver resection for benign liver tumors in a multicenter setting. Despite restrictive, tailored indications for resection in benign liver tumors, an increasing number of articles have been published concerning laparoscopic liver resection of these tumors. A retrospective study was performed in 18 surgical centres in Europe regarding their experience with laparoscopic resection of benign liver tumors. Detailed standardized questionnaires were used that focused on patient's characteristics, clinical data, type and characteristics of the tumor, technical details of the operation, and early and late clinical outcome. From March 1992 to September 2000, 87 patients suffering from benign liver tumor were included in this study: 48 patients with focal nodular hyperplasia (55%), 17 patients with liver cell adenoma (21%), 13 patients with hemangioma (15%), 3 patients with hamartoma (3%), 3 patients with hydatid liver cysts (3%), 2 patients with adult polycystic liver disease (APLD) (2%), and 1 patient with liver cystadenoma (1%). The mean size of the tumor was 6 cm, and 95% of the tumors were located in the left liver lobe or in the anterior segments of the right liver. Liver procedures included 38 wedge resections, 25 segmentectomies, 21 bisegmentectomies (including 20 left lateral segmentectomies), and 3 major hepatectomies. There were 9 conversions to an open approach (10%) due to bleeding in 45% of the patients. Five patients (6%) received autologous blood transfusion. There was no postoperative mortality, and the postoperative complication rate was low (5%). The mean postoperative hospital stay was 5 days (range, 2-13 days). At a mean follow-up of 13 months (median, 10 months; range, 2-58 months), all patients are alive without disease recurrence, except for the 2 patients with APLD. Laparoscopic resection of benign liver tumors is feasible and safe for selected patients with small tumors located in the left lateral segments or in the anterior segments of the right liver. Despite the use of a laparoscopic approach, selective indications for resection of benign liver tumors should remain unchanged. When performed by expert liver and laparoscopic surgeons in selected patients and tumors, laparoscopic resection of benign liver tumor is a promising technique.

Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study.

To assess the feasibility, safety, and outcome of laparoscopic liver resection for malignant liver tumors. The precise role of laparoscopy in resection of liver malignancies (hepatocellular carcinoma [HCC] and liver metastases) remains controversial despite an increasing number of publications reporting laparoscopic resection of benign liver tumors. A retrospective study was performed in 11 surgical centers in Europe regarding their experience with laparoscopic resection of liver malignancies. Detailed questionnaires were sent to each surgeon focusing on patient characteristics, clinical data, type and characteristics of the tumor, technical details of the operation, and early and late clinical outcome. All patients had radiologic investigations at follow-up to exclude disease recurrence. From February 1994 to December 2000, 37 patients with malignant liver tumors were included in this study. Ten patients had HCC, including 9 with cirrhotic liver, and 27 patients had liver metastases. The mean tumor size was 3.3 cm, and 89% of the tumors were located in the left lobe or in the anterior segments of the right liver. Liver procedures included 12 wedge resections, 9 segmentectomies, 14 bisegmentectomies (including 13 left lateral segmentectomies), and 2 major hepatectomies. The transfusion rate, the use of pedicular clamping, the conversion rate (13.5% in the whole series), and the complication rate were significantly greater in patients with HCC. There were no deaths. Postoperative complications occurred in eight patients (22%). The surgical margin was less than 1 cm in 30% of the patients. During a mean follow-up of 14 months, the 2-year disease-free survival was 44% for patients with HCC and 53% for patients having hepatic metastases from colorectal cancer. No port-site metastases were observed during follow-up. In patients with small malignant tumors, located in the left lateral segments or in the anterior segments of the right liver, laparoscopic resection is feasible and safe. The complication rate is low, except in patients with HCC on cirrhotic liver. By using laparoscopic ultrasound, a 1-cm free surgical margin should be routinely obtained. The late outcome needs to be evaluated in expert centers.