title: Laparoscopic Major Hepatectomy-Technique and Outcomes.
abstract: BACKGROUND
  With technological innovations especially newer parenchymal transection devices, improved understanding of hepatic anatomy facilitated by better imaging, and reconstructions along with experiences gained from advanced minimal invasive procedures, laparoscopic liver surgery is gaining momentum with more than 5300 reported cases worldwide. Most of the published literature comprises nonanatomical and segmental resections with only few case series having major hepatic resections performed by minimally invasive approach. Aim of this article is to share our technique and experience of total laparoscopic major hepatectomy.
  
  
  METHODS
  It is a retrospective analysis of prospectively maintained database of 56 patients, who underwent laparoscopic major hepatectomy for various indications during 2001 to 2013.
  
  
  RESULTS
  Of 56 patients operated, 37 had malignant disease and 19 had benign lesions with mean size of 6.0 ± 2.8 cm. Thirty-four patients underwent right hepatectomy and 22 left with mean age of 54.8 ± 15.3 years. Mean operating time was 227.4 ± 51.8 min with mean blood loss 265.5 ± 143.4 ml and transfusion needed in 10.7 %. Pringle's maneuver was used in 19.6 % with mean occlusion time of 34.0 ± 11.4 min. Liver-specific complications were observed in 12.5 % and overall complications in 19.6 %. Mean resection margin length in malignant lesions was 2.1 ± 0.9 cm, with <1 cm margin noted in 5.4 %. Median hospital stay was 8 days (6-29) with readmission rate of 8.9 %, re-intervention rate of 5.3 % and 90 days mortality of 1.7 %.
  
  
  CONCLUSIONS
  Laparoscopic major liver resection is a formidable task. It requires considerable expertise in both, advanced laparoscopy, and liver surgery. It can be feasible, safe, and oncologically adequate in well-selected cases in experience hands.
authors.affiliation: Department of HPB surgery, Gem Hospital and Research Centre, 45, Pankaja mills road, Ramnathapuram, Coimbatore, Tamil Nadu, India, 641045. senthilnathan94@gmail.com.
authors.forename: Senthilnathan
authors.initials: S
authors.lastname: Palanisamy
authors.affiliation: Department of HPB surgery, Gem Hospital and Research Centre, 45, Pankaja mills road, Ramnathapuram, Coimbatore, Tamil Nadu, India, 641045.
authors.forename: Sandeep C
authors.initials: SC
authors.lastname: Sabnis
authors.affiliation: Department of HPB surgery, Gem Hospital and Research Centre, 45, Pankaja mills road, Ramnathapuram, Coimbatore, Tamil Nadu, India, 641045.
authors.forename: Nikunj D
authors.initials: ND
authors.lastname: Patel
authors.affiliation: Department of HPB surgery, Gem Hospital and Research Centre, 45, Pankaja mills road, Ramnathapuram, Coimbatore, Tamil Nadu, India, 641045.
authors.forename: V P
authors.initials: VP
authors.lastname: Nalankilli
authors.affiliation: Department of HPB surgery, Gem Hospital and Research Centre, 45, Pankaja mills road, Ramnathapuram, Coimbatore, Tamil Nadu, India, 641045.
authors.forename: Anand
authors.initials: A
authors.lastname: Vijai
authors.affiliation: Department of HPB surgery, Gem Hospital and Research Centre, 45, Pankaja mills road, Ramnathapuram, Coimbatore, Tamil Nadu, India, 641045.
authors.forename: Praveenraj
authors.initials: P
authors.lastname: Palanivelu
authors.affiliation: Department of HPB surgery, Gem Hospital and Research Centre, 45, Pankaja mills road, Ramnathapuram, Coimbatore, Tamil Nadu, India, 641045.
authors.forename: Parthasarthi
authors.initials: P
authors.lastname: Ramkrishnan
authors.affiliation: Department of HPB surgery, Gem Hospital and Research Centre, 45, Pankaja mills road, Ramnathapuram, Coimbatore, Tamil Nadu, India, 641045.
authors.forename: Palanivelu
authors.initials: P
authors.lastname: Chinnusamy
mesh_terms: D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008107:Liver Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Hepatocellular carcinoma; Laparoscopic liver surgery; Liver resection; Major hepatectomy; Major liver resection