title: How does laparoscopic-assisted hepatic resection compare with the conventional open surgical approach?
abstract: BACKGROUND
  Laparoscopic-assisted hepatic resection (LAHR) has been described as a safe and reliable means of liver resection for tumors or live-donor hepatectomy. Here we compare the outcomes in paired cohorts between patients undergoing open hepatic resection (OHR) and LAHR.
  
  
  METHODS
  Two hundred and twelve patients who underwent either OHR or LAHR from March 2004 to July 2011 were analyzed to assess outcomes. During this time period, 124 patients underwent OHR and 88 underwent LAHR. Demographic and outcomes data were assessed.
  
  
  RESULTS
  In the total patient cohort, mean age found in both surgical arms was similar, as was the mean BMI. In addition, there was no difference in the cohort between those who underwent either minor or major hepatic resections (p = 0.52). Operatively, in the OHR arm the mean duration of the operation was 234 minutes and comparable with LAHR at 238 minutes (p = 0.75). There was also no difference in the mean lesion size in the OHR (5.72 cm) and LAHR (5.37 cm) groups (p = 0.55). Notably, there was no difference in the complication incidence rates, which were 10.5% (OHR) and 6.8% (LAHR) (p = 0.59). However, when analyzing for length of stay, there was a significant difference between the 2 arms; patients in OHR arm had longer stays than those in the LAHR arm (7.59 days vs 6.30 days, respectively; mean difference 1.29 days; 95% CI, 0.08-2.5; p = 0.036).
  
  
  CONCLUSIONS
  Although reduced surgical pain, improved cosmesis, and shortened hospital stays have been shown to correlate with laparoscopic abdominal procedures, our study indicates these marked advantages are also conferred to those undergoing LAHR. In addition, these findings demonstrate the use of LAHR and highlight the need for the addition of this technique to the liver surgeon's skill set.
authors.affiliation: Department of Surgery, Georgetown University Hospital, Washington, DC 20007, USA. lynt.johnson@medstar.net
authors.forename: Lynt B
authors.initials: LB
authors.lastname: Johnson
authors.forename: Jay A
authors.initials: JA
authors.lastname: Graham
authors.forename: David A
authors.initials: DA
authors.lastname: Weiner
authors.forename: John
authors.initials: J
authors.lastname: Smirniotopoulos
mesh_terms: D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000601:surgery; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies