Prospective assessment of the safety and benefit of laparoscopic liver resections.
OBJECTIVE
Laparoscopy represents an alternative to open surgery for virtually all digestive surgery procedures, with the anticipated short-term advantage of reduced esthetic prejudice, postoperative pain, and duration of in-hospital stay. In this study, we investigated the safety and benefits of laparoscopic liver resections in patients with benign solid liver tumors.


METHODS
Laparoscopic liver resection of up to two segments for benign liver tumor was performed under continuous carbon dioxide (CO(2)) pneumoperitoneum in 21 patients with no underlying chronic liver disease. The risk of gas embolism was assessed by end-tidal CO(2) and O(2) saturation, and the hemodynamic variations were monitored by a Swan-Ganz catheter. The postoperative course was compared with that following open surgery by matched-pair analysis.


RESULTS
No patient experienced gas embolism or was converted, and clamping of the hepatic pedicle resulted in hemodynamic variations comparable to those observed during open surgery. Duration of surgery (177 vs 156 min.), intraoperative blood loss (218 vs 285 ml), modifications of postoperative liver function tests, and incidence of postoperative complications (10% vs 10%) were comparable to those after open surgery. Laparoscopic resection was associated with a 50% reduction (15.5 vs 31.6 mg) in morphine consumption during the first postoperative days, a reduction of the delay to oral intake of 0.8 days, and a reduction of in-hospital stay of 1.4 days.


CONCLUSIONS
Liver resections of up to two segments can be performed by laparoscopy using the same technique as that used during open surgery. However, the benefits observed compared with open surgery appear to be limited.
Farges
Olivier
O
Department of Digestive Surgery and Liver Transplantation, Beaujon Hospital, 92118 Clichy cédex, France.
Jagot
Pascal
P
Kirstetter
Philippe
P
Marty
Jean
J
Belghiti
Jacques
J
D000236:Adenoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical; D004618:Embolism, Air / Q000209:etiology; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000601:surgery*; D006391:Hemangioma / Q000601:surgery*; D006439:Hemodynamics; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008102:Liver Circulation / Q000502:physiology; D008113:Liver Neoplasms / Q000601:surgery*; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome