Laparoscopic Liver Resection for Benign Disease

Abstract

Patients: Fifty patients with benign disease underwent laparoscopic liver resection. Indications for resection included preoperative diagnosis of adenoma or cystadenoma, uncertain preoperative diagnosis, and presence of symptoms. Inclusion criteria were lesions 5 cm or less located in the peripheral segments (segments 2-6).Intervention: Laparoscopic liver resection using a surgical technique including 5 ports, harmonic transection, stapling of large vessels, and extraction in a bag through a separate incision.Main Outcome Measures: Intraoperative results and postoperative morbidity.Results: Thirty-five patients (70%) presented with solid tumor; 11 (22%), with cystic lesions; and 4 (8%), with biliary disease. Tumor was solitary in 41 cases (82%) and multiple in 9 (18%). Mean (SD) surgical time was 191 (77.5) minutes (range, 30-480 minutes). There were 4 conversions (8%) and 1 patient received a transfusion (2%). There was no mortality. The postoperative morbidity rate was 10% and included only nonspecific complications. Median hospital stay was 5 days.Conclusions: Laparoscopic liver resection for benign disease can be recommended in patients with peripheral lesions requiring limited resection. Major resections may be performed in highly select patients but require further evaluation. Specific training is required. Indications for laparoscopic resection of benign liver disease must be the same as those for open surgery. Reduction of abdominal wall damage and cosmetic advantages of the laparoscopic approach represent a clear benefit in patients with benign liver disease.

Setorectomia posterior direita laparoscópica no tratamento dos tumores hepáticos

“…Machado, et al 14,15 did not observe comprised margins, although the series was small and almost all cases were colorectal metastasis. Like in other series, there was no mortality in the present series which leads to think that laparoscopic hepatectomy is generally a safe procedure 1,2,3,4,5,6,7,8,9,10,11,12,14,15,17,18 .…”

“…Hilar dissection, biliary or vascular repair, mobilization of the liver, and transection of the parenchyma are more technically demanding and potentially more dangerous than other laparoscopic procedures that have previously been reported. Anatomical hemihepatectomy requires a clear understanding of general liver anatomy, experience in advanced hepatobiliary surgery, and additionally, the ability to dissect major vascular and biliary structures using laparoscopic approach 1,2,3,4,5,6,11 .…”

“…With advances in laparoscopic instruments and parenchymal transection devices associated with improved experience of complex laparoscopic hepatobiliary resections; the use of laparoscopic hepatic resection has been growing, especially formal right hepatectomy or even mono and bi-segmentectomy of the right lobe. More recently, laparoscopic hepatectomy has been performed with dismal morbidity and low mortality in some referral centers 1,2,3,4,5,6,10,11,12,13,14,15,17,18 .…”

“…A lesão foi solitária em três casos (60 %). A média do tamanho das lesões foi 3,3 cm (1,. Foram analisados: tempo cirúrgico, sangramento operatório, morbimortalidade, tempo de internação e tempo de retorno à atividade habitual.…”

“…A mediana de retorno às atividades cotidianas foi de 12 dias (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). A mediana de seguimento foi de 13 meses (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Não houve recidiva de lesão.…”