Evolution of laparoscopic left lateral sectionectomy without the Pringle maneuver: through resection of benign and malignant tumors to living liver donation

Abstract

BackgroundLaparoscopic left lateral sectionectomy (LLS) has gained popularity in its use for benign and malignant tumors. This report describes the evolution of the authors’ experience using laparoscopic LLS for different indications including living liver donation.MethodsBetween January 2004 and January 2009, 37 consecutive patients underwent laparoscopic LLS for benign, primary, and metastatic liver diseases, and for one case of living liver donation. Resection of malignant tumors was indicated for 19 (51%) of the 37 patients.ResultsAll but three patients (deceased due to metastatic cancer disease) are alive and well after a median follow-up period of 20 months (range, 8–46 months). Liver cell adenomas (72%) were the main indication among benign tumors, and colorectal liver metastases (84%) were the first indication of malignancy. One case of live liver donation was performed. Whereas 16 patients (43%) had undergone a previous abdominal surgery, 3 patients (8%) had LLS combined with bowel resection. The median operation time was of 195 min (range, 115–300 min), and the median blood loss was of 50 ml (range, 0–500 ml). Mild to severe steatosis was noted in 7 patients (19%) and aspecific portal inflammation in 11 patients (30%). A median free margin of 5 mm (range, 5–27 mm) was achieved for all cancer patients. The overall recurrence rate for colorectal liver metastases was of 44% (7 patients), but none recurred at the surgical margin. No conversion to laparotomy was recorded, and the overall morbidity rate was 8.1% (1 grade 1 and 2 grade 2 complications). The median hospital stay was 6 days (range, 2–10 days).ConclusionsLaparoscopic LLS without portal clamping can be performed safely for cases of benign and malignant liver disease with minimal blood loss and overall morbidity, free resection margins, and a favorable outcome. As the ultimate step of the learning curve, laparoscopic LLS could be routinely proposed, potentially increasing the donor pool for living-related liver transplantation.

Laparoendoscopic single site (LESS) surgery for left-lateral hepatic sectionectomy as an alternative to traditional laparoscopy: case-matched analysis from a single center

“…Even if patient satisfaction should always be a major goal of surgery, in oncological surgery cosmesis has been traditionally considered a secondary priority so that application of laparoscopic techniques are accepted mainly for other advantages (i.e., faster recovery, lower immunosuppressive effect, better postoperative performance status for adjuvant chemotherapy). However, in liver surgery cosmesis may be a point of significant importance in some subsets of patients, including living donors of left-lateral sector and resections for benign diseases (i.e., adenomas, giant hemangioma of the left lobe) [24]. Indeed, the present study included some benign cases in both groups, even if the grade of patient satisfaction was not specifically addressed.…”

Laparoscopic liver resection in patients with liver cirrhosis—the path towards standard of care

“…Studies from other centers showed similar advantages (7)(8)(9)(10)(11). In the western literature, indication of liver resection was greatly governed by the Barcelona Clinic Liver Cancer classification (12).…”

The single surgeon learning curve of laparoscopic liver resection

“…To date, only a few papers have focused on this issue, mainly examining conversion rates (CRs) and blood loss. [ 11–17 ] However, it is difficult to draw final conclusions because many factors influence LC outcomes, such as the center and team experience, pathology referral, and individual surgical skills, allowing for the reproducibility of open techniques with the laparoscopic approach. Accordingly, the LC for laparoscopic minor hepatectomy is believed to be roughly completed after 60 procedures, allowing for the best performances in terms of conversion rates [15] …”