title: [Laparoscopic liver resection: lessons learned after 132 resections].
abstract: BACKGROUND
  After 20 years of experience in laparoscopic liver surgery there is still no clear definition of the best approach (totally laparoscopic [TLS] or hand-assisted [HAS]), the indications for surgery, position, instrumentation, immediate and long-term postoperative results, etc.
  
  
  OBJECTIVE
  To report our experience in laparoscopic liver resections (LLRs).
  
  
  METHODS
  Over a period of 10 years we performed 132 LLRs in 129 patients: 112 malignant tumours (90 hepatic metastases; 22 primary malignant tumours) and 20 benign lesions (18 benign tumours; 2 hydatid cysts). Twenty-eight cases received TLS and 104 had HAS.
  
  
  METHODS
  6 right hepatectomies (2 as the second stage of a two-stage liver resection); 6 left hepatectomies; 9 resections of 3 segments; 42 resections of 2 segments; 64 resections of one segment; and 5 cases of local resections.
  
  
  RESULTS
  There was no perioperative mortality, and morbidity was 3%. With TLS the resection was completed in 23/28 cases, whereas with HAS it was completed in all 104 cases. Transfusion: 4,5%; operating time: 150min; and mean length of stay: 3,5 days. The 1-, 3- and 5-year survival rates for the primary malignant tumours were 100, 86 and 62%, and for colorectal metastases 92, 82 and 52%, respectively.
  
  
  CONCLUSIONS
  LLR via both TLS and HAS in selected cases are similar to the results of open surgery (similar 5-year morbidity, mortality and survival rates) but with the advantages of minimally invasive surgery.
authors.affiliation: Unidad de Cirugía Hepática y Trasplante Hepático, Departamento de Cirugía, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España. Electronic address: rirocam@um.es.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Robles Campos
authors.forename: Caridad
authors.initials: C
authors.lastname: Marín Hernández
authors.forename: Asunción
authors.initials: A
authors.lastname: Lopez-Conesa
authors.forename: Vicente
authors.initials: V
authors.lastname: Olivares Ripoll
authors.forename: Miriam
authors.initials: M
authors.lastname: Paredes Quiles
authors.forename: Pascual
authors.initials: P
authors.lastname: Parrilla Paricio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Benign liver tumours; Cirugía hepática; Cirugía hepática laparoscópica; Hepatic metastases; Hepatocarcinoma; Laparoscopic liver surgery; Liver surgery; Metástasis hepáticas; Tumores hepáticos benignos