Evolution of a laparoscopic liver resection program: an analysis of 203 cases

Surg Endosc. 2017 Oct;31(10):4150-4155. doi: 10.1007/s00464-017-5468-2. Epub 2017 Mar 31.

Abstract

Background: 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.

Methods: 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).

Results: 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.

Conclusion: 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.

Keywords: Laparoscopic liver resection; Minimally invasive surgery; Pre-coagulation; Robotic liver resection.

MeSH terms

  • Blood Loss, Surgical
  • Blood Transfusion / statistics & numerical data
  • Carcinoma, Hepatocellular / surgery*
  • Conversion to Open Surgery / statistics & numerical data*
  • Female
  • Hepatectomy / methods
  • Hepatectomy / statistics & numerical data*
  • Humans
  • Laparoscopy / methods
  • Laparoscopy / statistics & numerical data*
  • Length of Stay
  • Liver Neoplasms / secondary
  • Liver Neoplasms / surgery*
  • Male
  • Middle Aged
  • Neoplasms, Multiple Primary / surgery*
  • Postoperative Complications / epidemiology
  • Robotic Surgical Procedures / methods
  • Robotic Surgical Procedures / statistics & numerical data*