Evaluation of 300 minimally invasive liver resections at a single institution: less is more.
OBJECTIVE
We present the largest, most comprehensive, single center experience to date of minimally invasive liver resection (MILR).


BACKGROUND
Despite anecdotal reports of MILR, few large single center reports have examined these procedures by comparing them to their open counterparts.


METHODS
Three hundred MILR were performed between July 2001 and November 2006 at our center for both benign and malignant conditions. These included 241 pure laparoscopic, 32 hand-assisted laparoscopic, and 27 laparoscopy-assisted open (hybrid) resections.These MILR were compared with 100 contemporaneous, cohort-matched open resections. MILR included segmentectomies (110), bisegmentectomies (63), left hepatectomies (47), right hepatectomies (64), extended right hepatectomies (8), and caudate lobe (8) resections. Benign etiologies encompassed cysts (70), hemangiomata (37), focal nodular hyperplasia (FNH) (23), adenomata (47), and 20 live donor right lobectomies. Malignant etiologies included primary (43) and metastatic (60) tumors. Hepatic fibrosis/cirrhosis was present in 25 of 103 patients with malignant diseases (24%).


RESULTS
There was high data consistency within the 3 types of MILR. MILR compared favorably with standard open techniques: operative times (99 vs. 182 minutes), blood loss (102 vs. 325 ml), transfusion requirement (2 of 300 vs. 8 of 100), length of stay (1.9 vs. 5.4 days), overall operative complications (9.3% vs. 22%), and local malignancy recurrence (2% vs. 3%). No port-site recurrences occurred. Conversion from laparoscopic to hand-assisted laparoscopic resection occurred in 20 patients (6%), with no conversions to open. No hand-assisted procedures were converted to open, but 2 laparoscopy-assisted (7%) were converted to open.


CONCLUSIONS
Our data show that MILR outcomes compare favorably with those of the open standard technique. Our experience suggests that MILR of varying magnitudes is safe and effective for both benign and malignant conditions.
Koffron
Alan J
AJ
Division of Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA. akoffron@nmh.org
Auffenberg
Greg
G
Kung
Robert
R
Abecassis
Michael
M
D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008107:Liver Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D016896:Treatment Outcome
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