title: Total laparoscopic management of lesions involving liver segment 7.
abstract: BACKGROUND
  Until recently, laparoscopic resection of tumors involving segment 7 (s7) of the liver was seen as a relative contraindication. We analyzed our experiences with laparoscopic resection of tumors in s7.
  
  
  METHODS
  Retrospective analysis of prospective database on operative and postoperative characteristics and surgical outcomes of patients in whom the intention was to remove tumors located in s7 of the liver laparoscopically. We defined two groups: those with laparoscopic metastasectomy of s7 (s7 group) and those undergoing laparoscopic right posterior sectionectomy (RPS group).
  
  
  RESULTS
  Of 400 patients undergoing laparoscopic liver resection, 20 patients (5 %) underwent total laparoscopic resections of tumors in s7 (7 metastasectomy of s7 and 13 RPS). The type of resection was decided on the basis of tumor size and location. Median age was 70 years (range 46-82), and the indication for surgery was mainly CRLM (n = 13, 65 %) and HCC (n = 4, 20 %). There was 1 (5 %) conversion. Mean operative times were 252 min (±69) for s7 and 271 min (±102) for RPS. The mean intraoperative blood loss was 400 mL (±493) for s7 and 625 mL (±363) for RPS. A Pringle maneuver was used in 86 % of patients in s7 group and 75 % of patients in RPS group. Mean total hospital stay was 4.6 days (±2.5) in s7 and 6.9 days (±7.8) for RPS. The overall R0 resection rate was 95 % (s7 100 %, RPS 92 %).
  
  
  CONCLUSIONS
  Although resection of lesions in s7 is technically demanding, a laparoscopic approach can be performed safely and effectively in experienced hands.
authors.affiliation: University Hospital Southampton NHS Foundation Trust, E Level, Tremona Road, Southampton, SO166YD, UK.
authors.forename: S R
authors.initials: SR
authors.lastname: Coles
authors.affiliation: University Hospital Southampton NHS Foundation Trust, E Level, Tremona Road, Southampton, SO166YD, UK.
authors.forename: M G
authors.initials: MG
authors.lastname: Besselink
authors.affiliation: University Hospital Southampton NHS Foundation Trust, E Level, Tremona Road, Southampton, SO166YD, UK.
authors.forename: K R
authors.initials: KR
authors.lastname: Serin
authors.affiliation: University Hospital Southampton NHS Foundation Trust, E Level, Tremona Road, Southampton, SO166YD, UK.
authors.forename: H
authors.initials: H
authors.lastname: Alsaati
authors.affiliation: University Hospital Southampton NHS Foundation Trust, E Level, Tremona Road, Southampton, SO166YD, UK.
authors.forename: P
authors.initials: P
authors.lastname: Di Gioia
authors.affiliation: University Hospital Southampton NHS Foundation Trust, E Level, Tremona Road, Southampton, SO166YD, UK.
authors.forename: M
authors.initials: M
authors.lastname: Samim
authors.affiliation: University Hospital Southampton NHS Foundation Trust, E Level, Tremona Road, Southampton, SO166YD, UK.
authors.forename: N W
authors.initials: NW
authors.lastname: Pearce
authors.affiliation: University Hospital Southampton NHS Foundation Trust, E Level, Tremona Road, Southampton, SO166YD, UK. abuhilal9@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Abu Hilal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Laparoscopy; Liver; Metastasectomy; Right posterior sectionectomy; Segment 7