Laparoscopic Liver Resections

Abstract

The authors present the rationale of the laparoscopic approach to liver surgery, showing the technique of fully endoscopic and endoscopic-assisted formal and wedge hepatic resections and the early results of their experience. From 1993 to 1997, 38 liver resections have been attempted through the laparoscopic or the laparoscopic assisted approach. Out of these 38 resections, 5 were wedge resections, 11 were segmentectomies, 10 were left formal hepatectomies, 1 was an extended left hepatectomy, 5 were bisegmentectomies, 5 were right formal hepatectomies, and 1 was an extended right hepatectomy. In two cases, one segmentectomy and one bisegmentectomy, the procedures were converted to open surgery. Wedge, segmental, and left liver resections were usually performed through a fully endoscopic approach, whereas right liver resections were accomplished by a video-assisted approach. In all but six cases, the resections were attempted for malignancy. There were no intra-operative deaths. One patient died on postoperative day-1 because of liver failure and severe coagulopathy. The early results are comparable to those of conventional surgery, with the benefits derived from minimal access surgery. Laparoscopic liver resections are technically feasible with an acceptable morbidity and mortality rate, but extensive experience in conventional liver surgery, advanced laparoscopic surgery, and the availability of all requested technology are indispensable prerequisites.

Recent advances in hepatic resection

“…The development of staplers and the harmonic stapler in particular have extended the indications for laparoscopic procedures. Several case reports or small series have been published [25][26][27][28]. However, minimally invasive resection of the liver has lagged behind that of other organs for the following reasons: 1) Many areas of the liver are difficult to access because of the liver's position high in the abdomen posterior to the ribs.…”

Laparoscopic Liver Resection for Benign Disease

“…1,2 Laparoscopic liver resection was first reported in 1992, 3 but unlike other areas of abdominal surgery, this approach has been developed in a very limited number of institutions. [4][5][6][7][8][9][10] Except for a few studies, most of the articles reported a limited number of patients, but it has been established that in select patients, laparoscopic liver resections, if performed in institutions with expertise in hepatic surgery and advanced laparoscopic procedures, are safe, with results identical to those of open surgery. [5][6][7][8][9]11,12 Resection for benign liver disease can represent a valid indication for the laparoscopic approach because of the absence of risk of tumoral dissemination.…”

“…5,8,21,29 Although most resections in this series were fewer than 3 segments, 8 major hepatectomies were performed for benign disease (16%). Three of the 4 conversions occurred during major resection, for a 37% conversion rate in major resections (2 were for bleeding and 1, for doubt on tumor limits in a patient with multiple adenomas).…”

“…The reduction of the abdominal wall damage is associated with decreased postoperative pain, reduced peritoneal adhesions, shorter hospital stay, and an earlier return to previous activity. 5,6,[22][23][24][25][26] Furthermore, 2 case-control studies have shown that, despite longer operating times, the laparoscopic procedure is associated with reduced blood loss and reduced morbidity. 27,28 Also, there are cosmetic advantages of the smaller incisions used in the laparoscopic approach.…”

Laparoscopic hepatic wedge resection of hemangioma: report of two cases

“…Recently, there have been a few reports of therapeutic laparoscopic liver operations, but most of the reports are limited to wedge resections [6,7]. However, successful larger hepatic resections have recently been reported in humans [8,9,10,11,12,13,14].…”