European experience of laparoscopic major hepatectomy

Abstract

Background/purpose Laparoscopic hepatectomies have seen a worldwide proliferation. Major anatomic resections, which were initially considered unsuitable for laparoscopy, are currently confined to a few centers of expertise. The aim of this study was to discuss the current trends and techniques in laparoscopic major hepatectomy in Europe. Methods The prospective databases of ten European centers were combined to provide answers to a questionnaire that had been addressed to all European teams known to perform laparoscopic liver surgery. Results Between 1996 and 2011 a total of 2245 laparoscopic liver resections have been carried out, of which 495 (22 %) were major resections. The proportion of laparoscopic right and left hepatectomies varied between 4 and 40 % of all major hepatectomies of the same type. Benign, primary malignant and metastatic lesions were, respectively, 22.4, 19.6 and 58 % of all indications. The different techniques and approaches, as regards hand assistance, hepatic inflow and outflow control, liver mobilization and concomitant colectomies, are discussed. Conclusions To date, an important level of experience of laparoscopic liver resection has been accumulated in Europe, and experience of major hepatectomies is constantly increasing. However, they remain technically very demanding procedures which should be confined to expert surgeons who have already acquired considerable experience with simpler laparoscopic liver resections.

Single-Port Laparoscopic Liver Resection: Largest Turkish Experience

“…SPL liver resection must be performed by surgeons experienced in laparoscopic and conventional hepatobiliary surgery [1][2][3]. The The laparoscopic liver retractor is helpful for traction during left hepatic vein transection.…”

“…This procedure has the advantage of reducing postoperative general complications such as ascites and wound infection without worsening the oncological outcome. Laparoscopy is preferred over conventional surgery in well-selected patients with cirrhosis with peripherally located tumors to reduce the postoperative deterioration [3][4][5].…”

“…Laparoscopic liver resection has been the standard treatment for peripherally located benign or malignant lesions in well-selected patients [1][2][3]. This procedure has the advantage of reducing postoperative general complications such as ascites and wound infection without worsening the oncological outcome.…”

Recent advances in surgical treatment of hepatocellular carcinoma

“…A group of experts met in Louisville, Kentucky, United States in 2008 and determined that the best indications for laparoscopy were solitary lesions, less than 5 cm in diameter, located in the anterior segments at a distance from the line of transection, the hepatic hilum, and the vena cava (61). Since that time, surgical indications have continued to evolve: tumor size alone is no longer a contraindication for laparoscopic surgery (62) and experienced facilities use laparoscopic resection to treat tumors in the posterior segments or center of the liver (63,64).…”

Can retrohepatic tunnel be quickly and easily established for laparoscopic liver hanging maneuver by Goldfinger dissector in laparoscopic right hepatectomy?

“…The clinical application of laparoscopic right hepatectomy (LRH) is also on the increase (Dagher et al, 2009;Han et al, 2010;Lainas et al, 2015). However, LRH still remains a challenging procedure owing to the technical difficulty (Pearce et al, 2011;Tzanis et al, 2013) of resecting the deepest and largest portion of the liver. Moreover, LRH is always considered risky, especially in patients with large tumors located in the right side of the liver, which is associated with potentially massive intraoperative bleeding and a high conversion rate.…”