title: Comparative benefits of laparoscopic vs open hepatic resection: a critical appraisal.
abstract: OBJECTIVE
  To perform a literature review examining the comparative benefits of laparoscopic vs open hepatic resection and to define the benefits and outcomes of laparoscopic liver resection in our own series of 314 patients.
  
  
  METHODS
  Cited English-language publications from PubMed. In addition, between 2001 to 2010, hepatic resections were performed in our institution in 1294 patients, of whom 314 patients (24.3%) underwent laparoscopic liver resection for benign or malignant liver lesions.
  
  
  METHODS
  Search phrases were "laparoscopic liver resection," "open liver resection," "versus," "compared with," and "advantages."
  
  
  METHODS
  Thirty-one studies were reviewed that directly compared laparoscopic with open hepatic resection in 2473 patients.
  
  
  RESULTS
  In case-cohort matched studies, and our institutional series, laparoscopic liver resection was associated with less blood loss, quicker resumption of oral diet, less pain medication requirement, and shorter length of stay, with no difference in complication rates. In those patients undergoing laparoscopic hepatic resection for malignancy, there was no difference in 3- or 5-year overall survival when compared with well-matched open hepatic resection cases. Financially, the total hospital costs of laparoscopic liver resection were either offset or improved because of a shorter length of stay.
  
  
  CONCLUSIONS
  Based on review of the literature and our institutional series, minimally invasive hepatic resection for benign and malignant liver lesions is safe and feasible with significant benefits for patients consisting of less blood loss, less narcotic requirements, and shorter length of hospital stay. There are no economic disadvantages to the laparoscopic approach, and case-cohort matched studies show no difference in oncologic outcomes between the laparoscopic and open groups.
authors.affiliation: University of Pittsburgh Medical Center Liver Cancer Center, University of Pittsburgh, Starzl Transplant Institute, 3459 Fifth Avenue, Pittsburgh, PA 15213-2582, USA.
authors.forename: Kevin Tri
authors.initials: KT
authors.lastname: Nguyen
authors.forename: J Wallis
authors.initials: JW
authors.lastname: Marsh
authors.forename: Allan
authors.initials: A
authors.lastname: Tsung
authors.forename: J Jennifer L
authors.initials: JJ
authors.lastname: Steel
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
authors.forename: David A
authors.initials: DA
authors.lastname: Geller
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007813:Laparotomy / Q000379:methods / Q000401:mortality; D008107:Liver Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome