[Laparoscopic hepatectomy].
Between 1997 and 2007, the celioscopic approach was used for 159 (23%) of the 698 hepatic resections performed at Henri Mondor Hospital. The main selection criteria were the location and size of the lesions. Most lesions were located in anterolateral segments (segments 2 to 6) and were smaller than 50 mm. With experience, the team started to perform major hepatectomies for more deep-seated lesions. The patients were 84 women and 75 men. The indications were benign in 65 cases (40%) and malignant in 94 cases (60%). The most frequent benign disorders were symptomatic hepatocyte tumors and tumors of uncertain nature (adenomas and focal nodular hyperplasia in 40 cases). The malignant lesions comprised 60 cases of hepatocellular carcinoma on a cirrhotic liver and 20 metastases of colorectal cancer. The tumors had a diameter of 44 mm (range 4-170 mm). The technique involved 5 trocars, pneumoperitoneum, and parenchymal section with a combination of a harmonic scalpel, an ultrasonic dissector, and automatic staplers. Intermittent pedicular clamping was used if necessary. The specimen was removed in a protective bag. Manual assistance was used in 14 cases (9%), while the other cases involved a pure coelioscopic approach. Major hepatectomy (three or more segments) was performed in 27 cases (17%) and minor resection in 132 cases (83%). There were 17 right hepatectomies, 11 left hepatectomies, 52 left lobectomies, 37 mono- or bisegmentectomies and 43 atypical resections. The overall laparotomic conversion rate was 10% (16 cases). The reasons for conversion were bleeding in 10 cases and inadequate exposure or progression in 6 cases. The mean operating time was 204 minutes. Nine patients (6%) received blood transfusions. There were no postoperative deaths and the morbidity rate was 18%. The mean resection margin for malignant tumors was 14 mm and there were no relapses on the trocar ports. This series demonstrates the feasibility of celioscopic hepatic resection in selected patients. These operations necessitate expertise in hepatic surgery and advanced coelioscopy, as well as sophisticated instrumentation. The advantages are those of minimally invasive surgery, and simpler re-operation for further hepatectomy or transplantation.
Cherqui
Daniel
D
Chirurgie digestive, Hôpital Henri Mondor, 51, avenue du Mal de Lattre de Tassigny, 94010 Créteil Cédex. daniel.cherqui@hmn.ap-hop-paris.fr
Laurent
Alexis
A
Tayar
Claude
C
Karoui
Mehdi
M
D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D013525:Surgical Instruments