title: Laparoscopic major hepatectomy: an evolution in standard of care.
abstract: OBJECTIVE
  To analyze the results of 6 international surgical centers performing laparoscopic major liver resections.
  
  
  BACKGROUND
  The safety and feasibility of laparoscopy for minor liver resections has been previously demonstrated. Major anatomic liver resections, initially considered to be unsuitable for laparoscopy, are increasingly reported by several centers worldwide.
  
  
  METHODS
  Prospective databases of 3 European, 2 U.S., and 1 Australian centers were combined. Between 1997 and 2008, 210 major liver resections were performed: 136 right and 74 left hepatectomies. Results and differences in surgical techniques between the 6 centers are outlined.
  
  
  RESULTS
  Surgical duration was 250 minutes (range: 90-655 minutes). Operative blood loss was 300 mL (range: 20-2500 mL). Thirty patients (14.3%) received blood transfusion. Conversion to open surgery was required in 26 patients (12.4%). Portal triad clamping was performed in 24 patients (11.4%). Median tumor size was 5.4 cm (range: 1-25 cm) and surgical margin was 10.5 mm (range: 0-70 mm). Two patients died during the postoperative period from pulmonary embolism and urosepsis. Liver-specific and general complications occurred in 17 (8.1%) and 29 patients (13.8%), respectively. Hospital length of stay was 6 days (range: 1-34 days). A further analysis of early (n = 90) and late (n = 120) experience showed improved surgical and postoperative results in the latter group.
  
  
  CONCLUSIONS
  This multicenter study demonstrates that laparoscopic major liver resections are feasible in selected patients and results improve with experience. However, proficiency in both open liver surgery and advanced laparoscopy is compulsory and surgeons must begin with minor laparoscopic resections.
authors.affiliation: Department of Surgery, Antoine Béclère Hospital, 157 rue de la Porte de Trivaux, 92141 Clamart cedex, France. ibrahim.dagher@abc.aphp.fr
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Dagher
authors.forename: Nicholas
authors.initials: N
authors.lastname: O'Rourke
authors.forename: David A
authors.initials: DA
authors.lastname: Geller
authors.forename: Daniel
authors.initials: D
authors.lastname: Cherqui
authors.forename: Giulio
authors.initials: G
authors.lastname: Belli
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Lainas
authors.forename: Alexis
authors.initials: A
authors.lastname: Laurent
authors.forename: Kevin Tri
authors.initials: KT
authors.lastname: Nguyen
authors.forename: Michael R
authors.initials: MR
authors.lastname: Marvin
authors.forename: Mark
authors.initials: M
authors.lastname: Thomas
authors.forename: Kadyalia
authors.initials: K
authors.lastname: Ravindra
authors.forename: George
authors.initials: G
authors.lastname: Fielding
authors.forename: Dominique
authors.initials: D
authors.lastname: Franco
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Buell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000075202:Contraindications; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008113:Liver Neoplasms; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D055815:Young Adult