Laparoscopic liver resection: a systematic review.
BACKGROUND
Outcomes of laparoscopic liver resection (LLR) are not clarified. The objective of this article is to depict the state of the art of LLR by means of a systematic review of the literature.


METHODS
Studies about LLR published before September 2008 were identified and their results summarized.


RESULTS
Indications for laparoscopic hepatectomy do not differ from those for open surgery. Technical feasibility is the only limiting factor. Bleeding is the major intraoperative concern, but, if managed by an expert surgeon, do not worsen outcomes. Hand assistance can be useful in selected cases to avoid conversion. Patient selection must take both tumor location and size into consideration. Potentially good candidates are patients with peripheral lesions requiring limited hepatectomy or left lateral sectionectomy; their outcomes, including reduced blood loss, morbidity, and hospital stay, are better than those of their laparotomic counterparts. The same advantages have been observed in cirrhotics. Laparoscopic major hepatectomies and resections of postero-superior segments need further evaluation. The results of LLR in cancer patients seem to be similar to those obtained with the laparotomic approach, especially in cases of hepatocellular carcinoma, but further analysis is required.


CONCLUSIONS
Laparoscopic liver resection is safe and feasible. The laparoscopic approach can be recommended for peripheral lesions requiring limited hepatectomy or left lateral sectionectomy. Preliminary oncological results suggest non-inferiority of laparoscopic to laparotomic procedures.
Viganò
Luca
L
Department of Digestive and Hepatobiliary Surgery, Hôpital Henri Mondor, Université Paris 12, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.
Tayar
Claude
C
Laurent
Alexis
A
Cherqui
Daniel
D
D000818:Animals; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D015179:Colorectal Neoplasms / Q000473:pathology; D000075202:Contraindications; D004618:Embolism, Air / Q000453:epidemiology; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D018579:Patient Selection; D011028:Pneumoperitoneum, Artificial; D016896:Treatment Outcome