The International Position on Laparoscopic Liver Surgery (original) (raw)
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Laparoscopic Liver Resection—Understanding its Role in Current Practice
Annals of Surgery, 2009
To report our complete experience with laparoscopic liver resection (LLR) to understand what role it may play in the broader context of liver surgery. Background: The goal of LLR is to extend the benefits of the laparoscopic approach without compromising the fundamental principles of open liver surgery. LLR, however, presents unique technical challenges and its evaluation is made difficult by the restricted indications for this approach, the few centers worldwide experienced in the technique, and the heterogeneity of procedures and pathologies involved. Methods: Retrospective analysis of a prospectively maintained database of liver resections from a unit with a comprehensive liver program, including resection and transplantation. Results: There were 166 laparoscopic liver resections between May 23, 1996 and December 31, 2007, including 100 (60%) for malignant pathology (64 HCC, 3 cholangiocarcinoma, 33 hepatic metastases) and 66 for benign pathology (adenoma, 23; FNH, 19; cystic, 17; other, 7). Numbers of resections for benign indications remained stable over time whereas those for malignant indications increased. There were 31 major resections, 56 left lateral sectionectomies, 28 segmentectomies, and 51 tumorectomies. There was 0% mortality and 15.1% morbidity. Median blood loss was 200 mL, 9 patients (5.4%) required transfusion, and median operating time was 180 minutes. Left lateral sectionectomies demonstrated reduced bleeding (median, 175 vs. 300 mL, P ϭ 0.0015) and faster operating time (median, 170 vs. 180 minutes, P ϭ 0.0265). In the second half of the experience, there was reduced bleeding (median, 200 vs. 300 mL, P ϭ 0.0022) and a lower conversion rate (2.4% vs. 16.9%, P ϭ 0.0015). Conclusions: Good patient selection and refined surgical technique are the keys to successful LLR. The indications for resection of asymptomatic benign lesions should not be increased because the laparoscopic approach is available. Hepatocellular carcinomas (HCCs) are more likely to be suitable to a laparoscopic approach than colorectal liver metastases. Left lateral sectionectomy and limited resection of solitary peripheral lesions are particularly suitable while hemihepatectomies remain challenging procedures. LLR requires an ongoing robust audit to identify any emerging problems.
Laparoscopic Liver Resection—Current Update
Surgical Clinics of North America, 2010
• Laparoscopic liver resection • Laparoscopic hepatic resection • Liver cancer • HCC • Colorectal cancer metastases Laparoscopic hepatic resection is an emerging option in the field of hepatic surgery. With almost 3000 laparoscopic hepatic resections reported in the literature for benign and malignant tumors, with a combined mortality of 0.3% and morbidity of 10.5%, there will be an increasing demand for minimally invasive liver surgery. 1 Multiple series have been published on laparoscopic liver resections; however, no randomized controlled trial has been reported that compares laparoscopic with open liver resection. Large series, meta-analyses, and reviews have thus far attested to the feasibility and safety of minimally invasive hepatic surgery for benign and malignant lesions. 2-17 The largest single-center experience was published by Koffron and colleagues 3 and describes various minimally invasive approaches to liver resection, including pure laparoscopic, hand-assisted laparoscopic, and laparoscopic-assisted open (hybrid) techniques. The choice of the minimally invasive approach should depend on surgeon experience, tumor size, location, and the extent of liver resection.
Best Practice & Research Clinical Gastroenterology, 2014
In the past two decades there has been an enormous increase in laparoscopic liver surgery. There is a trend from limited to laparoscopic major resections and more centres are adopting laparoscopic liver surgery as a standard of care. Although no randomized clinical trials are published, different reports on minor and major hepatectomies and meta-analyses suggest (at least) equal outcomes and cost-effectiveness compared to open procedures.
Surgical oncology, 2018
Laparoscopic liver resection is rapidly increasing, and certain types of resection are considered standard procedures for liver resection, especially for small malignant tumors located on the liver surface or in the anterolateral segments of the liver. Several specialized centers have performed many types of highly complex hepatectomies, anatomical resections, and laparoscopic donor hepatectomies. Even though several international consensus conferences and expert meetings have been held, until now there have been no practical guidelines for beginners or experts conducting laparoscopic liver resection. We describe here practical guidelines for performing laparoscopic liver resection, including the indications, technical considerations, and training required.
International experience for laparoscopic major liver resection
Journal of hepato-biliary-pancreatic sciences, 2014
Although minor laparoscopic liver resections (LLRs) appear as standardized procedures, major LLRs are still limited to few expert teams. The aim of this study was to report the combined data of 18 international centers performing major LLR. Variables evaluated were number and type of LLR, surgical indications, number of synchronous colorectal resections, details on technical points, conversion rates, operative time, blood loss and surgical margins. From 1996 to 2014, a total of 5388 LLR were carried out including 1184 major LLRs. The most frequent indication for laparoscopic right hepatectomy (LRH) was colorectal liver metastases (37.0%). Seven centers used hand assistance or hybrid approach selectively for LRH mostly at the beginning of their experience. Seven centers apply Pringle's maneuver routinely. The conversion rate for all major LLRs was 10% and mean operative time was 291 min. Mean estimated blood loss for all major LLR was 327 ml and negative surgical margin rate was ...
Laparoscopic liver surgery: new frontiers
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2011
Laparoscopic liver resection (LHR) has shown classical advantages of minimally invasive surgery over open counterpart. In spite of introduction in early 1990's only few centres worldwide adapted LHR to routine practice. It was due to considerable technical challenges and uncertainty about oncologic outcomes. Surgical instrumentation and accumulation of surgical experience has largely enabled to solve many technical considerations. Intraoperative navigation options have also been improved. Consequently indications have been drastically expanded nearly reaching criteria equal to open liver resection in expert centres. Recent studies have verified oncologic integrity of LHR. However, mastering of LHR is still a quite demanding task limiting expansion of this patient friendly technique. This emphasizes the necessity of systematic training for laparoscopic liver surgery. This article reviews the state of the art of laparoscopic liver surgery lightening burning issues of research and ...
Journal of Minimal Access Surgery, 2005
Though still practiced in only a few centres worldwide, laparoscopic liver resections, particularly left hepatectomy offer advantages over the conventional open approach in two important respects: reduced operative blood loss and lower major postoperative morbidity. Two approaches are used: the totally laparoscopic and the hand-assisted technique, which in the author's opinion facilitates both the execution and safety of these procedures, especially major resection of the right liver (right hepatectomy and pluri-segmentectomies). Technologies, which have enabled hepatic resections include: laparoscopic contact ultrasound, linear cutting staplers, ultrasonic dissection, LigaSure and TissueLink. The components operative steps necessary for these resections as practised by the author are described in this review.
Laparoscopic Liver Resection: Current Status and Techniques
World Journal of Laparoscopic Surgery with DVD, 2015
Laparoscopy has forever changed the landscape of surgery. Although hepatobiliary surgery remained the last bastion of 'maximal invasiveness,' recently there has been a rise in the implementation of laparoscopy for complex liver operations. Liver surgeons have been slow to adopt the laparoscopic technique for liver resections. This new approach has offered the patient an alternative to the traditional bilateral subcostal incision, and thereby tendered the marked benefits of limited incisions inherent to minimally invasive surgery. As efficiency pressures continue to rise, the laparoscopic approach for liver resection will likely be further embraced. To this end, we surmise that the hybrid technique will gain favor, as it more closely assimilates the skills that hepatobiliary surgeons already possess. Moreover, this technique offers the most palatable setting of safety with the use of the hand for liver mobilization and prompt control of bleeding vasculature. Liver surgery, although initially late to embrace laparoscopy, is now gaining momentum in this paradigm shift. The advent of innovative tools that mirror what is used conventionally have facilitated this transition.
Laparoscopic Liver Resection Introduction
The explosive growth in the popularity of laparoscopic surgery and the widespread acceptance of laparoscopic cholecystectomy has encouraged surgeons to apply laparoscopic methods to the management of a number of hepatic tumors. Many comparative studies favor the laparoscopic approach over open surgery in hepatic resection for several reasons. The aim of this work is assessment of feasibility, safety and efficacy of laparoscopic liver resection. In conclusion, laparoscopic liver resections for benign and malignant hepatic tumors, performed by surgeons with adequate training and in selected patients are safe, feasible and effective. Small tumors located in the left-lateral segment are the most favorable for the laparoscopic approach. It is associated with a low morbidity and mortality.