title: Laparoscopic liver resection for hepatocellular adenoma.
abstract: OBJECTIVE
  To investigate the role of laparoscopy in the surgical management of hepatocellular adenoma (HA).
  
  
  METHODS
  We reviewed a prospectively collected database of consecutive patients undergoing laparoscopic liver resection for HA.
  
  
  RESULTS
  Thirteen patients underwent fifteen pure laparoscopic liver resections for HA (male/female: 3/10; median age 42 years, range 22-72 years). Two patients with liver adenomatosis required two different laparoscopic operations for ruptured adenomas. Indications for surgery were: symptoms in 12 cases, need to rule out malignancy in 2 cases and preoperative diagnosis of large HA in one case. Symptoms were related to bleeding in 10 cases, sepsis due to liver abscess following embolization of HA in one case and mass effect in one case (shoulder tip pain). Five cases with ruptured bleeding adenoma required emergency admission and treatment with selective arterial embolization. Laparoscopic liver resection was then semi-electively performed. Eight patients (62%) required major hepatectomy [right hepatectomy (n = 5), left hepatectomy (n = 3)]. No conversion to open surgery occurred. The median operative time for pure laparoscopic procedures was 270 min (range 135-360 min). The median size of the excised lesions was 85 mm (range 25-180 mm). One patient with adenomatosis developed postoperative bleeding requiring embolization. Mortality was nil. The median hospital stay was 4 d (range 1-18 d) with a median high dependency unit stay of 1 d (range 0-7 d).
  
  
  CONCLUSIONS
  The laparoscopic approach represents a safe option for the management of HA in a semi-elective setting and when major hepatectomy is required.
authors.affiliation: Hepatobiliary and Pancreatic Surgical Unit, Southampton University Hospitals NHS Trust, Tremona Road, Southampton SO16 6YD, United Kingdom.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Abu Hilal
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Fabio
authors.forename: Robert David
authors.initials: RD
authors.lastname: Wiltshire
authors.forename: Mohammed
authors.initials: M
authors.lastname: Hamdan
authors.forename: David M
authors.initials: DM
authors.lastname: Layfield
authors.forename: Neil William
authors.initials: NW
authors.lastname: Pearce