title: Hand-assisted laparoscopic surgery for liver tumors.
abstract: BACKGROUND
  The surgical treatment for liver tumors, whether metastatic or hepatic in origin, traditionally used the open approach through large incisions. In recent years the laparoscopic approach became popular but few centers use this method routinely.
  
  
  OBJECTIVE
  To assess the results of our initial experience with liver resection using the laparoscopic approach, in terms of patient safety and oncologic surgical outcome.
  
  
  METHODS
  Between August 2007 and April 2008 we performed 10 liver resections in 9 patients using the hand-assisted laparoscopic surgery technique.
  
  
  RESULTS
  The main indication for surgery was metastatic colorectal carcinoma in seven patients and hepatocellular carcinoma in two. The mean age was 67 +/- 11 years. The tumor was solitary in seven patients. Five patients had neoadjuvant chemotherapy. Altogether, 12 lesions with an average size of 17 +/- 9 mm were resected. The mean operative time was 180 +/- 52 minutes. Average postoperative stay was 6.5 +/- 3.5 days. There was no perioperative mortality. There was one conversion to open surgery due to bleeding from the left hepatic vein. No major perioperative complications were encountered. All resected margins were free of malignancy.
  
  
  CONCLUSIONS
  Liver resection using HALS is safe and feasible and should be considered in selected patients.
authors.affiliation: Department of Surgery A, Carmel Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-lsrael Institute of Technology, Haifa, Israel.
authors.forename: Yariv
authors.initials: Y
authors.lastname: Salit
authors.forename: Arie
authors.initials: A
authors.lastname: Bitterman
authors.forename: Oleg
authors.initials: O
authors.lastname: Lefel
authors.forename: Dorit
authors.initials: D
authors.lastname: Eisenberg
authors.forename: Arieh
authors.initials: A
authors.lastname: Eden
authors.forename: Menache
authors.initials: M
authors.lastname: Barzelai
authors.forename: Mariana
authors.initials: M
authors.lastname: Steiner
authors.forename: Eli
authors.initials: E
authors.lastname: Zuckerman
authors.forename: Riad
authors.initials: R
authors.lastname: Haddad
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D015179:Colorectal Neoplasms / Q000473:pathology; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D016896:Treatment Outcome