Starting a new laparoscopic liver surgery program: initial experience and improved efficiency

Abstract

Background: Owing to the anatomic complexity of the liver and the risk of hemorrhage, most liver resections are still performed using an open procedure. We evaluated the outcomes of introducing a laparoscopic liver program to a community teaching hospital. Methods:We retrospectively reviewed laparoscopic liver resections performed between August 2010 and July 2013 at St. Joseph's Health Centre in Toronto. The primary outcomes were mortality, major morbidity and negative margins. Secondary outcomes included other perioperative outcomes. We used nonparametric tests to compare the outcomes during the first (group A) and second (group B) halves of the study period.Results: Group A included 19 patients and group B had 25 patients; 9 and 4 patients, respectively, had major resections. Group A had the only death due to liver failure. There was no difference in major complications (10.6% v. 16%) or length of stay (4.5 v. 4.6 d) between the groups. One patient in group B had a positive margin. There was a significant decrease in duration of surgery (from 237 to 170 min, p = 0.007), with a trend toward shorter duration for major resections (from 318 to 238 min, p = 0.07). Furthermore, more procedures were performed for malignancy in group B than group A (36.8% v. 84.0%, p = 0.001). Conclusion:Laparoscopic liver resection can be safely introduced into a Canadian community teaching hospital. Average duration of surgery decreased by 67 minutes despite a 2-fold increase in the number of cases performed for malignancy. Résultats : Le groupe A incluait 19 patients et le groupe B, 25 patients; 9 et 4 patients, respectivement, ont subi des résections majeures. Le groupe A a enregistré le seul décès attribuable à une insuffisance hépatique. On n'a noté aucune différence quant aux complications majeures (10,6 % c. 16 %) ou quant à la durée de l'hospitalisation (4,5 c. 4,6 jours) entre les groupes. Un patient du groupe B a présenté une marge positive. On a noté en général une diminution significative de la durée de l'intervention (de 237 à 170 minutes, p = 0,007); dans le cas des résections majeures, on a noté une tendance à la diminution de la durée de l'intervention (de 318 à 238 mi nutes, p = 0,07). En outre, un plus grand nombre d'interventions ont été effectuées pour des cas de cancer dans le groupe B que dans le groupe A (36,8 % c. 84,0 %, p = 0,001). Conclusion :La résection hépatique laparoscopique peut être pratiquée de manière sécuritaire dans un hôpital d'enseignement communautaire canadien. La durée moyenne des interventions a diminué de 67 minutes, malgré une augmentation du double du nombre d'interventions effectuées pour des cas de cancer.

Evolution of laparoscopic liver resection at Singapore General Hospital: a nine-year experience of 195 consecutive resections

“…(16) Nonetheless, it is important to note that more recent studies have demonstrated that the learning curve of LLR can now be shortened. (14,15,19) This has been attributed to recent advancements in laparoscopic equipment as well as improvements in the surgical technique of LLR.…”

Electric- Field-Modified In Situ Precise Deposition of Electrospun Medical Glue Fibers on the Liver for Rapid Hemostasis

“…Liver resection is an effective way to treat cancers in the liver [ 1 ]. However, heavy bleeding usually occurs in liver resection due to the abundant blood vessel in this special site [ 2 ].…”