Laparoscopic liver resection: results for 70 patients.
BACKGROUND
Laparoscopy is slowly becoming an established technique for liver resection. This procedure still is limited to centers with experience in both hepatic and laparoscopic surgery. Preliminary reports include mainly minor resections for benign liver conditions and show some advantage in terms of postoperative recovery. The authors report their experience with laparoscopic liver resection, the evolution of the technique, and the results.


METHODS
From 1999 to 2006, 70 laparoscopic liver resections were performed using a procedure similar to resection by laparotomy.


RESULTS
There were 38 malignant tumors (54%) and 32 benign lesions (46%). The malignant tumors were mainly hepatocellular carcinomas (19 of 24 patients had cirrhosis). The tumor mean size was 3.8 +/- 1.9 cm (range, 2.2-8 cm). There were 19 major hepatectomies, 34 uni- or bisegmentomies, and 17 atypical resections. The operative time was 227 +/- 109 min. Conversion to laparotomy was required for seven patients (10%), mainly for continuous bleeding during transection. Nine patients (13%) required blood transfusion. One patient had both brisk bleeding and gas embolism from a tear in the section line of the right hepatic vein requiring laparoscopic suture. Blood loss and transfusion requirements were significantly lower in recent than in early cases and in resections with prior vascular control than in those without such control. Postoperative complications were experienced by 11 patients (16%), including one bleed from the hepatic stump requiring hemostasis and two subphrenic collections requiring percutaneous drainage. One cirrhotic patient died of liver failure after resection of a partially ruptured tumor. No ascites was observed in other cirrhotic patients. The mean hospital stay was 5.9 days.


CONCLUSIONS
The study results confirm that laparoscopic liver resection, including major hepatectomies, can be safely performed by laparoscopy.
Dagher
I
I
Department of General Surgery, Antoine Beclere Hospital, Paris-Sud School of Medicine, 157 Avenue de la Porte de, Trivaux, 92141, Clamart, France. dagheri@yahoo.com
Proske
J M
JM
Carloni
A
A
Richa
H
H
Tranchart
H
H
Franco
D
D
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D005602:France; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D007813:Laparotomy / Q000706:statistics & numerical data; D007902:Length of Stay; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010149:Postoperative Pain / Q000453:epidemiology; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome