title: A new approach to hand-assisted laparoscopic liver surgery.
abstract: BACKGROUND
  The best type of laparoscopic approach in solid liver tumours (SLTs), whether total laparoscopic surgery or hand-assisted laparoscopic surgery (HALS), has not yet been established. Our objective is to present our experience with laparoscopic liver resections in SLTs performed by HALS using a new approach.
  
  
  METHODS
  We performed 35 laparoscopic resections in SLTs, of which 26 were carried out using HALS (in 25 patients) and 21 patients had liver metastases of a colorectal origin (LMCRC) (1 patient had 2 resections), 1 metastasis from a neuroendocrine tumour of the pancreas, 1 hepatocarcinoma on a healthy liver, 1 primary hepatic leiomyosarcoma and 1 giant haemangioma. Mean follow-up was 22 months. OPERATION: One right hemihepatectomy, one left hemihepatectomy, five bisegmentectomies II-III, three bisegmentectomies VI-VII and 16 segmentectomies (five of S. VI, three of S. VIII; three of S. V; two of S. IVb; one of S. II; one of S. IV; and in the remaining case resection of S. III and VI plus resection of a metastasis in S. VIII).
  
  
  METHODS
  Morbidity and mortality, conversion to open procedure, intraoperative blood loss, intra- and postoperative transfusion, length of stay and survival.
  
  
  RESULTS
  There were no intra- or postoperative deaths, nor were there any conversions. One patient presented with morbidity (3.8%) (liver abscess). Mean blood loss was 200 ml (range 0-600 ml). One patient required transfusion (3.8%). Mean operative time was 180 min (range 120-360 min). Mean length of hospital stay was 4 days (range 2-5 days). The actuarial survival rate of the patients at 36 months with liver metastases from colorectal carcinoma (LMCRC) was 80%.
  
  
  CONCLUSIONS
  Liver resection with HALS reproduces the low morbidity and mortality rates and effectiveness (3-year survival) of open surgery in SLTs when indicated selectively.
authors.affiliation: Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain. rirocam@um.es
authors.forename: Ricardo
authors.initials: R
authors.lastname: Robles
authors.forename: Caridad
authors.initials: C
authors.lastname: Marín
authors.forename: Beatriz
authors.initials: B
authors.lastname: Abellán
authors.forename: Asunción
authors.initials: A
authors.lastname: López
authors.forename: Patricia
authors.initials: P
authors.lastname: Pastor
authors.forename: Pascual
authors.initials: P
authors.lastname: Parrilla
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000473:pathology; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome