Laparoscopic major hepatectomy: an evolution in standard of care.
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.
Dagher
Ibrahim
I
Department of Surgery, Antoine Béclère Hospital, 157 rue de la Porte de Trivaux, 92141 Clamart cedex, France. ibrahim.dagher@abc.aphp.fr
O'Rourke
Nicholas
N
Geller
David A
DA
Cherqui
Daniel
D
Belli
Giulio
G
Gamblin
T Clark
TC
Lainas
Panagiotis
P
Laurent
Alexis
A
Nguyen
Kevin Tri
KT
Marvin
Michael R
MR
Thomas
Mark
M
Ravindra
Kadyalia
K
Fielding
George
G
Franco
Dominique
D
Buell
Joseph F
JF
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