Laparoscopic liver resections: a feasibility study in 30 patients - PubMed (original) (raw)

Laparoscopic liver resections: a feasibility study in 30 patients

D Cherqui et al. Ann Surg. 2000 Dec.

Abstract

Objective: To assess the feasibility and safety of laparoscopic liver resections.

Summary background data: The use of the laparoscopic approach for liver resections has remained limited for technical reasons. Progress in laparoscopic procedures and the development of dedicated technology have made it possible to consider laparoscopic resection in selected patients.

Methods: A prospective study of laparoscopic liver resections was undertaken in patients with preoperative diagnoses including benign lesion, hepatocellular carcinoma with compensated cirrhosis, and metastasis of noncolorectal origin. Hepatic involvement had to be limited and located in the left or peripheral right segments (segments 2-6), and the tumor had to be 5 cm or smaller. Surgical technique included CO2 pneumoperitoneum and liver transection with a harmonic scalpel, with or without portal triad clamping or hepatic vein control. Portal pedicles and large hepatic veins were stapled. Resected specimens were placed in a bag and removed through a separate incision, without fragmentation.

Results: From May 1996 to December 1999, 30 of 159 (19%) liver resections were included. There were 18 benign lesions and 12 malignant tumors, including 8 hepatocellular carcinomas in cirrhotic patients. Mean tumor size was 4.25 cm. There were two conversions to laparotomy (6.6%). The resections included 1 left hepatectomy, 8 bisegmentectomies (2 and 3), 9 segmentectomies, and 11 atypical resections. Mean blood loss was 300 mL. Mean surgical time was 214 minutes. There were no deaths. Complications occurred in six patients (20%). Only one cirrhotic patient developed postoperative ascites. No port-site metastases were observed in patients with malignant disease.

Conclusion: Laparoscopic resections are feasible and safe in selected patients with left-sided and right-peripheral lesions requiring limited resection. Young patients with benign disease clearly benefit from avoiding a major abdominal incision, and cirrhotic patients may have a reduced complication rate.

PubMed Disclaimer

Figures

None

Figure 1. Typical port placement for resection of lesions located in segments 2 through 5. The patient is in the supine position with lower limbs apart, the surgeon between the legs.

None

Figure 2. Typical port placement for resection of lesions in segment 6. The patient is in the left lateral decubitus position for right lobe mobilization and posterior exposure. The table can be turned to the right to tilt or flip the right lobe against the diaphragm and gain anterior access.

None

Figure 3. Laparoscopic bisegmentectomy 2 and 3. The portal triad is clamped. The middle and left hepatic veins are taped and can be readily clamped if necessary. Liver transection is performed with a harmonic scalpel. Larger structures are divided with a linear stapler.

None

Figure 4. Locations of treated lesions according to Couinaud’s classification. Shaded areas are considered consistent with laparoscopic resection. Numbers in white squares are the number of lesions in each corresponding segment.

None

Figure 5. Examples of benign lesions. (A) Angiomyolipoma of segment 2; bisegmentectomy 2 and 3. (B) Hepatocellular adenoma of the right lobe with extrahepatic development; atypical resection. (C) Polycystic liver disease with left predominance; multiple unroofing and bisegmentectomy 2 and 3. (D) Focal nodular hyperplasia of segment 6; segmentectomy 6.

None

Figure 6. Examples of hepatocellular carcinomas in cirrhotic patients. (A) Lesion of segment 6 recurring after percutaneous ethanol injection in an atrophic right lobe with hypertrophy of segments 1, 2, and 3; segmentectomy 6. (B) Lesion of segment 3; segmentectomy 3. (C) Lesions of segment 6; segmentectomy 6. (D) Lesion of segment 4 with initial presentation by spontaneous rupture treated with chemoembolization and subsequent segmentectomy 4.

Similar articles

Cited by

References

    1. John TG, Greig JD, Crosbie JL, Miles WF, Garden OJ. Superior staging of liver tumors with laparoscopy and laparoscopic ultrasound. Ann Surg 1994; 220: 711–719. - PMC - PubMed
    1. Rahusen F, Cuesta MA, Borgstein PJ, et al. Selection of patients for resection of colorectal metastases to the liver using diagnostic laparoscopy and laparoscopic ultrasonography. Ann Surg 1999; 230: 31–37. - PMC - PubMed
    1. Morino M, De Giuli M, Festa V, Garrone C. Laparoscopic management of symptomatic nonparasitic cysts of the liver. Ann Surg 1994; 219: 157–164. - PMC - PubMed
    1. Hashizume M, Takenaka K, Yanaga K, et al. Laparoscopic hepatic resection for hepatocellular carcinoma. Surg Endosc 1995; 9: 1289–1291. - PubMed
    1. Gugenheim J, Mazza D, Katkhouda N, Goubaux B, Mouiel J. Laparoscopic resection of solid liver tumours. Br J Surg 1996; 83: 334–335. - PubMed

Publication types

MeSH terms

LinkOut - more resources