title: The value of laparoscopic liver surgery for solid benign hepatic tumors.
abstract: BACKGROUND
  Laparoscopic liver resection (LLR) has gained wide acceptance for various liver resection procedures, mainly for benign diseases. However, only small series have been reported from a few selected centers.
  
  
  METHODS
  Between January 2001 and January 2006, a total of 629 liver resections were performed at our institution. The indication was solid benign liver tumor in 56 (8.9%) patients. LLR was performed in 20 (35.7%) cases. Data from the LLR group were compared with those from a consecutive control group undergoing open liver surgery (OS) for similar indications in a matched-pair analysis during the same period. The pairs were matched as closely as possible for age, gender, American Society of Anesthesiologists (ASA) score, indication for resection, and type and location of the lesions. The endpoint was to investigate overall morbidity and outcome.
  
  
  RESULTS
  All patients but one are alive and well after a mean follow-up of 35 months (range 10-60 months). Conversion laparotomy was required in two out of 20 (10%) cases for uncontrolled bleeding (one requiring temporary hemodialysis). LLR was characterized by faster time to first oral intake and shorter hospital stay compared to OS (p = 0.001 and 0.008, respectively). Incisional hernias (25%) were only recorded in the OS (p = 0.047 vs. LLR). Overall morbidity was 45% in OS versus 20% in LLR (p = 0.3).
  
  
  CONCLUSIONS
  LLR significantly reduced time to oral intake, hospital stay, and incisional hernias compared to OS. Bleeding is a major risk and should be carefully considered when resecting benign tumors. In the hands of expert surgeons, LLR may become the gold standard for the resection of benign liver tumors located in the anterior and lateral sectors and for minor hepatic resections.
authors: Dept. of General Surgery, Hepato-Biliary and Liver Transplantation Service, Ghent University Hospital Medical School, De Pintelaan 185, 2K12 IC, Ghent, 9000, Belgium. roberto.troisi@ugent.be
authors: Roberto
authors: R
authors: Troisi
authors: Roberto
authors: R
authors: Montalti
authors: Peter
authors: P
authors: Smeets
authors: Jacques
authors: J
authors: Van Huysse
authors: Hans
authors: H
authors: Van Vlierberghe
authors: Isabelle
authors: I
authors: Colle
authors: Steven
authors: S
authors: De Gendt
authors: Bernard
authors: B
authors: de Hemptinne
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D009367:Neoplasm Staging; D010149:Postoperative Pain / Q000503:physiopathology; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
references: World J Surg. 1997 Nov-Dec;21(9):983-90; discussion 990-1
references: 9361515
references: Ann Surg. 1999 Apr;229(4):460-6
references: 10203077
references: Ann Chir. 2002 Mar;127(3):164-70
references: 11933628
references: Surg Endosc. 1998 Jan;12(1):76-8
references: 9419311
references: Gut. 1991 Jun;32(6):677-80
references: 2060877
references: Ann Surg. 1988 Nov;208(5):558-64
references: 3190282
references: Surgery. 2004 Oct;136(4):804-11
references: 15467665
references: Gut. 1991 May;32(5):524-7
references: 2040476
references: J Hepatol. 1993 Jul;18(3):276-8
references: 8228119
references: Br J Surg. 2007 Jan;94(1):58-63
references: 17054316
references: Surg Endosc. 2003 Dec;17(12):1914-8
references: 14574547
references: Surg Endosc. 2002 Jun;16(6):899-904
references: 12163951
references: Radiology. 1994 Nov;193(2):507-12
references: 7972769
references: Hepatogastroenterology. 1998 Nov-Dec;45(24):2333-8
references: 9951918
references: Cancer. 1991 Jul 15;68(2):341-7
references: 1712664
references: Surg Endosc. 2003 Jan;17(1):23-30
references: 12364994
references: Hum Pathol. 2005 Nov;36(11):1210-6
references: 16260275
references: Am Surg. 1996 Oct;62(10 ):825-9
references: 8813164
references: Lancet. 1980 Feb 9;1(8163):273-6
references: 6101735
references: Hepatology. 1995 Dec;22(6):1674-81
references: 7489973
references: J Hepatobiliary Pancreat Surg. 2002;9(2):242-8
references: 12140614
references: Hepatology. 2006 Dec;44(6):1694-700
references: 17133494
references: Br J Surg. 2006 Jan;93(1):67-72
references: 16273531
references: Surg Endosc. 1996 Jul;10(7):758-61
references: 8662435
references: J Hepatobiliary Pancreat Surg. 2005;12(5):351-5
references: 16258801
references: J Hepatol. 1996;25 Suppl 1:30-4
references: 8954189
references: World J Surg. 1995 Jan-Feb;19(1):13-8
references: 7740799
references: World J Surg. 1995 Jan-Feb;19(1):19-24
references: 7740805
references: J Clin Ultrasound. 1996 Sep;24(7):345-50
references: 8873856
references: Ann Surg. 2000 Dec;232(6):753-62
references: 11088070
references: Surgery. 2007 Feb;141(2):203-211
references: 17263977
references: Chirurg. 2002 May;73(5):474-80
references: 12089832
references: J Am Coll Surg. 2003 Feb;196(2):236-42
references: 12595052
references: Surg Gynecol Obstet. 1992 May;174(5):403-7
references: 1315081