[Laparoscopic liver surgery: analyze the experience on 36 cases].
We analyze the experience in laparoscopic liver surgery in the Department of General Surgery and Liver Transplantation of Fundeni Clinical Institute between september 1998 and march 2003. This study includes 36 patients, 24 females (66.7%) and 12 males (33.3%) with ages between 25 and 67 and a mean age of 46 years. From the group of 36 patients with liver pathology considered for laparoscopic treatment 6 cases had multiple hepatic lesions with no preop diagnosis. The postoperative diagnosis was neoplasia in 4 cases, noncellular necrosis with chronic inflammation in one case and focal nodular hyperplasia in another case. The fenestration and drainage were used as laparoscopic treatment in case of 7 patients with nonparasitic liver cysts. Nine patients from our group had hydatid cysts. In 7 patients the treatment consisted in partial pericystectomy after inactivation and parasite evacuation. In 2 patients an ideal pericystectomy was performed for cysts located in segments II and III. The solid lesions selected for laparoscopic treatment were in 3 cases benign symptomatic tumors with no preoperative diagnosis, in 9 cases symptomatic hemangioma and in 2 cases malignant lesions. From these 14 patients in only 2 cases the lesions were located in the right antero lateral segments. Only in the case of metastasis a left lateral sectorectomy was performed, in all other cases a nonanatomical resection being performed. Conversion to open surgery was necessary in 11.11% of cases (2 hemangioma, 2 partial pericystectomies) for bleeding control. In our study we had no mortality and 11.11% morbidity. The follow-up was available in all patients for a mean time of 18 months (10 to 36). A CT scan was made in all patients with solid lesions 6 months after surgery and an ultrasound examination in all other cases. All patients were nonsymptomatic at repeated reevaluations. We are now at the beginning of laparoscopic liver surgery and these results need to be confirmed. The benefits seem to be those of any miniinvasive surgery: reduced trauma to the abdominal wall, early mobilization, shorter hospital stay, better aesthetics.
Institutul Clinic Fundeni, Centrul de Chirurgie Generală şi Transplant Hepatic Sos, Fundeni, nr. 258, Bucureşti, sector 2. irinel.popescu@icfundeni.ro
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Popescu
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Tomulescu
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Hrehoreţ
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Kosa
D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000601:surgery; D003560:Cysts / Q000601:surgery; D004444:Echinococcosis, Hepatic / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006391:Hemangioma / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008107:Liver Diseases / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies