Approaches to laparoscopic liver resection: a meta-analysis of the role of hand-assisted laparoscopic surgery and the hybrid technique

Abstract

Laparoscopic liver resection has been established as a safe and feasible treatment option. Surgical approaches include pure laparoscopy, hand-assisted laparoscopy (HALS), and the hybrid technique. The role of these three approaches, and their superiority over open laparotomy, is not yet known. A literature review was performed using specific search phrases, relating to hand-assisted or hybrid approaches to laparoscopic liver resection. Surgical results from 18 case series (HALS, nine series; hybrid technique, nine series), each with ≥10 patients, were analyzed. Results indicated that HALS was associated with a mean operative time of 82-264.5 min, an estimated blood loss of 82-300 mL, and a complication rate of 3.8-27.1%. Analysis of series involving the hybrid technique indicated a mean operative time of 111-366.5 min, an estimated blood loss of 93-936 mL, and a complication rate of 3.4-23.5%. In conclusion, there is insufficient evidence to conclude that any single approach is superior to the others, although HALS and the hybrid technique are useful when dealing with difficulties associated with pure laparoscopy. Conversely, the need for these two methods, which can function as a bridge to pure laparoscopic liver resection, may be overcome with appropriate training.

Evolution and revolution of laparoscopic liver resection in Japan

“…These expert technical recommendations will never be confirmed by level 1 evidence, but still need to be shared so that beginners can benefit from expert guidance. Another major achievement of the consensus conferences is the publication activities related to the conferences and the systematic reviews prepared to develop recommendations before the Morioka Consensus Conference 46, 67, 84, 118, 119, 120, 121, 122. We hope that all these publications will contribute to the safe uptake of LLR.…”

A máj VII-es szegmentumában igazolt áttéti daganat laparoszkópos reszekciója

“…Létezik tisztán laparoszkópos, "handassist ed" és a hibrid technika, amelyek közül a két utób-bit legtöbben a nehéz, komplikált eseteknél javasolják alkalmazni [8,9]. Annak ellenére, hogy míg kezdetben csak az elöl fekvő szegmentumok esetében ajánlották a laparoszkópos technikát, mára minden szegmentum megközelítésére létezik kidolgozott technika, illetve a nagyobb anatómiai reszekciók is biztonsággal kivitelezhetők [10][11][12][13][14].…”

Systematic reviews from the 2nd International Consensus Conference on Laparoscopic Liver Resection

“…In this issue, primary authors of several CQs [3][4][5][6][7][8] present their systematic reviews that were prepared to create recommendations before the ICCLLR (Figs 1,2). A comprehensive literature review was performed and analysis was done using multiple case series, case-control studies, reviews, and metaanalyses published over the last several years.…”

“…CQ10 What is the role of HALS and the hybrid method? [4] Techniques CQ11 What has changed in the concept of liver resection? CQ12 What are the essentials of bleeding control in LLR?…”