title: Hand-assisted laparoscopic liver surgery.
abstract: OBJECTIVE
  The hand-assisted laparoscopic technique may be applied to the treatment of liver tumors.
  
  
  METHODS
  A case series with mean follow-up of 13 months.
  
  
  METHODS
  University-affiliated tertiary care center.
  
  
  METHODS
  A total of 15 patients with hepatic neoplasms underwent screening tests, including appropriate tumor marker analyses, abdominal sonography, and computed tomographic scan and, in most cases, magnetic resonance imaging to determine operability. Contraindications included extrahepatic disease, more than 5 liver lesions, coagulopathy, and ascites.
  
  
  METHODS
  Between March 1, 1998, and April 30, 2001, 15 patients underwent 16 hand-assisted diagnostic laparoscopic operations to rule out extrahepatic disease. Four patients had extrahepatic disease. In the 11 patients without evidence of extrahepatic disease, intraoperative ultrasound was used to establish the number and location of liver lesions. Operative strategies included resection, cryoablation, or both.
  
  
  METHODS
  Operative time, conversion to open procedure, length of stay, complications, and recurrence of disease.
  
  
  RESULTS
  Of the 15 patients with liver tumors, 6 patients had more extensive disease than was detected by either preoperative imaging or laparoscopic exploration They included extrahepatic disease (3), additional liver lesion (2), or both (1). Hand-assisted management included resection only (3), cryoablation only (5), and a combination of the 2 (3). A total of 9 lesions were resected and 10 lesions were cryoablated. The mean operative time was 197 minutes with a mean length of stay of 4.5 days. There were no conversions to open procedures. One patient experienced minor postoperative bleeding but required no treatment. All treated patients are alive, and 5 have had recurrence of disease.
  
  
  CONCLUSIONS
  Hand-assisted technique can be applied safely and effectively to laparoscopic liver surgery and may identify presence of otherwise undetectable disease.
authors.affiliation: Department of Surgery, Hartford Hospital and University of Connecticut School of Medicine, Hartford, CT, USA.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Antonetti
authors.forename: Brigid
authors.initials: B
authors.lastname: Killelea
authors.forename: Rocco
authors.initials: R
authors.lastname: Orlando
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003452:Cryosurgery; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local