The International Position on Laparoscopic Liver Surgery (original) (raw)
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 ...
Lessons from Laparoscopic Liver Surgery: A Nine-Year Case Series
HPB Surgery, 2008
Objective. This series describes a developing experience in laparoscopic liver surgery presenting results from 40 procedures including right hemihepatectomy, left lateral lobectomy, and microwave ablation therapy. Methods. Forty patients undergoing laparoscopic liver surgery between September 1997 and November 2006 were included. The data set includes: operative procedure and duration, intraoperative blood loss, conversion to open operation rates, length of hospital stay, complications, mortality, histology of lesions/resection margins, and disease recurrence. Results. Mean age of patient: 59 years, 17/40 male, 23/40 female, 23/40 of lesions were benign, and 17/40 malignant. Operations included: laparoscopic anatomical resections n = 15, nonanatomical resections n = 11, microwave ablations n = 8 and deroofing of cysts n = 7. Median anaesthetic time: 120 minutes (range 40-240), mean blood loss 78 mL and 1/40 conversions to open. Median resection margins were 10 mm (range 1-14) and median length of stay 3 days (range 1-10). Operative and 30-day mortality were zero with no local disease recurrence. Conclusion.
Laparoscopic Liver Resection: Lessons Learned After 132 Resections
Cirugía Española (English Edition), 2013
Benign liver tumours Hepatic metastases Hepatocarcinoma Laparoscopic liver surgery Palabras clave: Cirugía hepá tica a b s t r a c t Introduction: After 20 years of experience in laparoscopic liver surgery there is still no clear definition of the best approach (totally laparoscopic [TLS] or hand-assisted [HAS]), the indications for surgery, position, instrumentation, immediate and long-term postoperative results, etc. Aim: To report our experience in laparoscopic liver resections (LLRs). Patients and method: Over a period of 10 years we performed 132 LLRs in 129 patients: 112 malignant tumours (90 hepatic metastases; 22 primary malignant tumours) and 20 benign lesions (18 benign tumours; 2 hydatid cysts). Twenty-eight cases received TLS and 104 had HAS. Surgical technique: 6 right hepatectomies (2 as the second stage of a two-stage liver resection); 6 left hepatectomies; 9 resections of 3 segments; 42 resections of 2 segments; 64 resections of one segment; and 5 cases of local resections.
Laparoscopic liver resection: benefits and controversies
Surgical Clinics of North America, 2004
In 1992, Gagner et al reported the first complex laparoscopic liver resection for a 6 cm, focal nodular hyperplasia, using an ultrasonic dissector, monopolar cautery, and clip appliers [1]. In 1995, Ferzli et al reported excision of 8 Â 9 cm segment IV hepatic adenoma, using ultrasonic dissector and endoscopic vascular staplers [2]. The first successful laparoscopic anatomical hepatectomy was reported in 1996 by Azagra et al, who performed a left lateral segmentectomy (segments II and III) in a patient with a benign adenoma of segments II and III .
Annals of surgery, 2015
The use of laparoscopy for liver surgery is increasing rapidly. The Second International Consensus Conference on Laparoscopic Liver Resections (LLR) was held in Morioka, Japan, from October 4 to 6, 2014 to evaluate the current status of laparoscopic liver surgery and to provide recommendations to aid its future development. Seventeen questions were addressed. The first 7 questions focused on outcomes that reflect the benefits and risks of LLR. These questions were addressed using the Zurich-Danish consensus conference model in which the literature and expert opinion were weighed by a 9-member jury, who evaluated LLR outcomes using GRADE and a list of comparators. The jury also graded LLRs by the Balliol Classification of IDEAL. The jury concluded that MINOR LLRs had become standard practice (IDEAL 3) and that MAJOR liver resections were still innovative procedures in the exploration phase (IDEAL 2b). Continued cautious introduction of MAJOR LLRs was recommended. All of the evidence ...