A new approach to hand-assisted laparoscopic liver surgery

Abstract

Liver resection with HALS reproduces the low morbidity and mortality rates and effectiveness (3-year survival) of open surgery in SLTs when indicated selectively.

Early Hand-Assisted Laparoscopic Resection of Ruptured Hepatocellular Carcinoma

“…2 Furthermore, laparoscopic LR is associated with improved perioperative and short-term outcomes such as decreased hospital stay and decreased blood loss. 2 HALS LR has been advocated by some authors as an alternative to pure laparoscopy, 6,13 especially for "technically difficult" resections. 6 Hand control of the liver may theoretically allow for a better margin of resection, decrease blood loss by direct compression, and improve surgical exposure.…”

“…2 HALS LR has been advocated by some authors as an alternative to pure laparoscopy, 6,13 especially for "technically difficult" resections. 6 Hand control of the liver may theoretically allow for a better margin of resection, decrease blood loss by direct compression, and improve surgical exposure. 6,14,15 It may be adopted during the learning curve by surgeons beginning to perform laparoscopic liver surgery.…”

“…6 Hand control of the liver may theoretically allow for a better margin of resection, decrease blood loss by direct compression, and improve surgical exposure. 6,14,15 It may be adopted during the learning curve by surgeons beginning to perform laparoscopic liver surgery. It can also be used as a salvage approach when complications such as bleeding arise during pure laparoscopy as an alternative to open conversion.…”

“…[2][3][4][5] However, because of the technical complexity of the totally laparoscopic approach, various other minimally invasive approaches have been described for LR, including the hand-assisted laparoscopic (HALS) and laparoscopicassisted (hybrid) approaches. 2,6 There has been no clear demonstrable advantage or definitive selection criteria for the various approaches, although in general the handassisted or hybrid approaches have been used for more "technically challenging" operations such as major hepatectomy, resection of larger tumors, tumors close to major vasculature, and tumors arising from difficult locations such as the right posterior or superior segments. 6 A recent review reported that HALS LR comprise only 16.5% of LRs performed worldwide.…”

“…2,6 There has been no clear demonstrable advantage or definitive selection criteria for the various approaches, although in general the handassisted or hybrid approaches have been used for more "technically challenging" operations such as major hepatectomy, resection of larger tumors, tumors close to major vasculature, and tumors arising from difficult locations such as the right posterior or superior segments. 6 A recent review reported that HALS LR comprise only 16.5% of LRs performed worldwide.…”