title: Bleeding and hemostasis in laparoscopic liver surgery.
abstract: BACKGROUND
  Minimally invasive liver resection is gaining acceptance worldwide. However, the laparoscopic approach often is reserved for small segmental resections due to the fear of significant blood loss. The expansion of laparoscopic liver surgery will depend on the ability of expert surgeons and technological advances to address the management of bleeding and hemostasis with any new approach. The 4(1/2)- year experience of a single center performing totally laparoscopic liver resections is presented, with special reference to the techniques the authors have developed to limit blood loss.
  
  
  METHODS
  Between 2003 and 2007, 80 patients underwent laparoscopic liver surgery for benign and malignant conditions including colorectal cancer metastases (n = 31), hepatocellular carcinoma (n = 6), neuroendocrine tumor (n = 3), cystic lesion (n = 10), adenoma (n = 8), and focal nodular hyperplasia (n = 7). Totally laparoscopic resections included sectionectomy (n = 27), hemihepatectomy (n = 10), and single/multiple segmentectomies (n = 21). Data for all resections were recorded and analyzed retrospectively to assess blood loss, hospital stay, and morbidity.
  
  
  RESULTS
  The median operative time was 150 min, and the median blood loss was 120 ml, with significantly more blood loss for right-sided transections than for the left liver surgery (821 vs 147 ml; p = 0.012). Four (57%) of seven resections converted to open procedures because of bleeding. No deaths occurred, and only two patients required intraoperative blood transfusions. There were eight complications and one bile leak. The median length of hospital stay was 3 days.
  
  
  CONCLUSIONS
  The authors' experience with 80 totally laparoscopic liver resections over a 4(1/2)-year period demonstrates that laparoscopic liver surgery is safe and effective in experienced hands for major resections. An intimate knowledge of the technology and techniques available for preventing and managing significant hemorrhage during laparoscopic liver resection is required for all surgeons performing laparoscopic liver surgery.
authors.affiliation: Hepato-Biliary-Pancreatic and Laparoscopic Surgical Unit, Southampton University Hospital, Southampton SO16 6YD, UK. abu_hlal@yahoo.com
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abu Hilal
authors.forename: Tim
authors.initials: T
authors.lastname: Underwood
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Taylor
authors.forename: Khaled
authors.initials: K
authors.lastname: Hamdan
authors.forename: Hassan
authors.initials: H
authors.lastname: Elberm
authors.forename: Neil W
authors.initials: NW
authors.lastname: Pearce
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control*; D006488:Hemostasis, Surgical; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome