title: Initial experience with laparoscopic hepatic resection at a comprehensive cancer center.
abstract: BACKGROUND
  Over the past few years, surgeons have been able to obtain training in advanced minimally invasive surgery (MIS) for hepatic, pancreatic, and biliary (HPB) cases instead of having to teach themselves these complex techniques. As a result, the initial experience of a surgeon with advanced MIS HPB training at a national cancer center was reviewed.
  
  
  METHODS
  The experience of a surgeon with the first 50 laparoscopic hepatectomies for cancer was reviewed retrospectively. All cases begun with the intention to complete the hepatectomy laparoscopically were included in the laparoscopic group.
  
  
  RESULTS
  From November 2008 to October 2010, a total of 57 hepatectomies were performed, with 53 attempted laparoscopically. Of these 57 hepatectomies, 46 (87%) were completed laparoscopically, 4 (7%) required hand assistance, and 3 (6%) were converted to an open approach. Laparoscopic minor hepatectomies were performed for 28 patients and laparoscopic major hepatectomies for 25 patients. The mean operative time was 265 min, and the mean estimated blood loss was 300 ml. The mean hospital stay was 7 days. Complications occurred for six patients (11%) (2 bile leaks, 2 hemorrhages requiring conversion, 1 hernia requiring a hernia repair on postoperative day 7, and 1 ileus managed nonoperatively).
  
  
  CONCLUSIONS
  Surgeons with advanced MIS HPB training may be able to perform a higher percentage of their hepatectomies laparoscopically. Training in both open and laparoscopic HPB surgery is advisable before these techniques are performed.
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, C-308, Philadelphia, PA 19111, USA. aagumbs@gmail.com
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Gumbs
authors.forename: Tzu-jung
authors.initials: TJ
authors.lastname: Tsai
authors.forename: John P
authors.initials: JP
authors.lastname: Hoffman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D006498:Hepatectomy / Q000193:education / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000193:education / Q000379:methods*; D007902:Length of Stay; D008113:Liver Neoplasms / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies