title: Evolution of a laparoscopic liver resection program: an analysis of 203 cases.
abstract: Techniques for laparoscopic liver resection (LLR) have been developed over the past two decades. The aim of this study is to analyze the outcomes and trends of LLR.
  
  
  
  203 patients underwent LLR between 2006 and 2015. Trends in techniques and outcomes were assessed dividing the experience into 2 periods (before and after 2011).
  
  
  
  Tumor type was malignant in 62%, and R0 resection was achieved in 87.7%. Procedures included segmentectomy/wedge resection in 64.5%. Techniques included a purely laparoscopic approach in 59.1% and robotic 12.3%. Conversion to open surgery was necessary in 6.4% cases. Mean hospital stay was 3.7 ± 0.2 days. 90-day mortality was 0% and morbidity 20.2%. Pre-coagulation and the robot were used less often, while the performance of resections for posteriorly located tumors increased in the second versus the first period.
  
  
  
  This study confirms the safety and efficacy of LLR, while describing the evolution of a program regarding patient and technical selection. With building experience, the number of resections performed for posteriorly located tumors have increased, with less reliance on pre-coagulation and the robot.
authors.affiliation: Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Elshamy
authors.affiliation: Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
authors.forename: Hideo
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
authors.forename: Muhammet
authors.initials: M
authors.lastname: Akyuz
authors.affiliation: Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
authors.forename: Pinar
authors.initials: P
authors.lastname: Yazici
authors.affiliation: Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
authors.forename: Hakan
authors.initials: H
authors.lastname: Yigitbas
authors.affiliation: Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
authors.forename: Abdulrahman Y
authors.initials: AY
authors.lastname: Hammad
authors.affiliation: Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
authors.forename: Federico N
authors.initials: FN
authors.lastname: Aucejo
authors.affiliation: Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Quintini
authors.affiliation: Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
authors.forename: John
authors.initials: J
authors.lastname: Fung
authors.affiliation: Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA. berbere@ccf.org.
authors.forename: Eren
authors.initials: E
authors.lastname: Berber
mesh_terms: D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data*; D005260:Female; D006498:Hepatectomy / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data*; D007902:Length of Stay; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D065287:Robotic Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*
keywords: Laparoscopic liver resection; Minimally invasive surgery; Pre-coagulation; Robotic liver resection