Lessons from Laparoscopic Liver Surgery: A Nine-Year Case Series

Abstract

Objective. This series describes a developing experience in laparoscopic liver surgery presenting results from 40 procedures including right hemihepatectomy, left lateral lobectomy, and microwave ablation therapy. Methods. Forty patients undergoing laparoscopic liver surgery between September 1997 and November 2006 were included. The data set includes: operative procedure and duration, intraoperative blood loss, conversion to open operation rates, length of hospital stay, complications, mortality, histology of lesions/resection margins, and disease recurrence. Results. Mean age of patient: 59 years, 17/40 male, 23/40 female, 23/40 of lesions were benign, and 17/40 malignant. Operations included: laparoscopic anatomical resections n = 15, nonanatomical resections n = 11, microwave ablations n = 8 and deroofing of cysts n = 7. Median anaesthetic time: 120 minutes (range 40–240), mean blood loss 78 mL and 1/40 conversions to open. Median resection margins were 10 mm (range 1–14) and median length of stay 3 days (range 1–10). Operative and 30-day mortality were zero with no local disease recurrence. Conclusion. Laparoscopic liver surgery appears safe and effective and is associated with reduced hospital stay. Larger studies are required to confirm it is oncologically sound.

Laparoscopic liver resection: a systematic review

“…Some authors have compared oncological results of laparoscopic and laparotomic surgery, including those of any kind of malignant lesion, and reported a similar margin width, recurrence risk, and overall survival rates [14, 23, 27, 45, 76, 77, 85]. Intraoperative laparoscopic ultrasonography has been associated with an increased rate of negative margins [19, 85].…”

“…Little data are available on the LLR of colorectal liver metastases; only two papers have specifically focused on this topic [29, 46]. Further data are available from other laparoscopic series [10, 12, 23, 24, 30, 35, 40, 42, 43, 85], but such data are often incomplete and heterogeneous. Most relevant series are summarized in Table 5.…”

Laparoscopic hepatectomy: A systematic review, meta-analysis, and power analysis

“…26 Coaptive coagulation uses a low temperature (50-100°C) to denature proteins in the tissues, forming a hemostatic protein coagulum that seals vessels and bile ducts. 34 Therefore, various surgical devices and techniques were used in the studies according to the historical background. Even though the superiority between these particular devices has not yet been proven, a surgical device bias could not be eliminated in the present meta-analysis.…”

Microwave Coagulation Therapy Combined with Laparoscopic Liver Resection for Hepatocellular Carcinoma in Cirrhotic Patients

“…Some studies comparing laparoscopic versus open procedures have demonstrated that the laparoscopic procedure may well be associated with less blood loss than open equivalents [16,17]. This observation may be due to the tamponading effect of a pneumoperitoneum [19]. Hence, blood loss could be minimized with this technique.…”