title: Laparoscopic major hepatectomies: clinical outcomes and classification.
abstract: BACKGROUND
  According to the Louisville Statement, laparoscopic major hepatectomy is a heterogeneous category that includes "traditional" trisectionectomies/hemi-hepatectomies and the technically challenging resection of segments 4a, 7, and 8. The aims of this study were to assess differences in clinical outcomes between laparoscopic "traditional" major hepatectomy and resection of "difficult-to-access" posterosuperior segments and to define whether the current classification is clinically valid or needs revision.
  
  
  METHODS
  We reviewed a prospectively collected single-center database of 390 patients undergoing pure laparoscopic liver resection. A total of 156 patients who had undergone laparoscopic major hepatectomy according to the Louisville Statement were divided into two subcategories: laparoscopic "traditional" major hepatectomy (LTMH), including hemi-hepatectomies and trisegmentectomies, and laparoscopic "posterosuperior" major hepatectomy (LPMH), including resection of posterosuperior segments 4a, 7, and 8. LTMH and LPMH subgroups were compared with respect to demographics, intraoperative variables, and postoperative outcomes.
  
  
  RESULTS
  LTMH was performed in 127 patients (81 %) and LPMH in 29 (19 %). Operation time was a median 330 min for LTMH and 210 min for LPMH (p < 0.0001). Blood loss was a median 500 ml for LTMH and 300 ml for LPMH (p = 0.005). Conversion rate was 9 % for LTMH and nil for LPMH (p = 0.219). In all, 28 patients (22 %) developed postoperative complications after LTMH and 5 (17 %) after LPMH (p = 0.801). Mortality rate was 1.6 % after LTMH and nil after LPMH. Hospital stay was a median 5 days after LTMH and 4 days after LPMH (p = 0.026).
  
  
  CONCLUSIONS
  The creation of two subcategories of laparoscopic major hepatectomy seems appropriate to reflect differences in intraoperative and postoperative outcomes between LTMH and LPMH.
authors.affiliation: Department of Hepato-Biliary and Pancreatic Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK, difabiof@hotmail.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Fabio
authors.forename: Morsal
authors.initials: M
authors.lastname: Samim
authors.forename: Paolo
authors.initials: P
authors.lastname: Di Gioia
authors.forename: Rosemary
authors.initials: R
authors.lastname: Godeseth
authors.forename: Neil W
authors.initials: NW
authors.lastname: Pearce
authors.forename: Mohammed
authors.initials: M
authors.lastname: Abu Hilal
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D061887:Conversion to Open Surgery; D016208:Databases, Factual; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000145:classification* / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000145:classification* / Q000401:mortality; D007902:Length of Stay; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies