Authors: Mohammad Abu Hilal Tim Underwood Matthew G Taylor Khaled Hamdan Hassan Elberm Neil W Pearce
Publish Date: 2009/07/16
Volume: 24, Issue: 3, Pages: 572-577
Abstract
Minimally invasive liver resection is gaining acceptance worldwide However the laparoscopic approach often is reserved for small segmental resections due to the fear of significant blood loss The expansion of laparoscopic liver surgery will depend on the ability of expert surgeons and technological advances to address the management of bleeding and hemostasis with any new approach The 4½ year experience of a single center performing totally laparoscopic liver resections is presented with special reference to the techniques the authors have developed to limit blood lossBetween 2003 and 2007 80 patients underwent laparoscopic liver surgery for benign and malignant conditions including colorectal cancer metastases n = 31 hepatocellular carcinoma n = 6 neuroendocrine tumor n = 3 cystic lesion n = 10 adenoma n = 8 and focal nodular hyperplasia n = 7 Totally laparoscopic resections included sectionectomy n = 27 hemihepatectomy n = 10 and single/multiple segmentectomies n = 21 Data for all resections were recorded and analyzed retrospectively to assess blood loss hospital stay and morbidityThe median operative time was 150 min and the median blood loss was 120 ml with significantly more blood loss for rightsided transections than for the left liver surgery 821 vs 147 ml p = 0012 Four 57 of seven resections converted to open procedures because of bleeding No deaths occurred and only two patients required intraoperative blood transfusions There were eight complications and one bile leak The median length of hospital stay was 3 daysThe authors’ experience with 80 totally laparoscopic liver resections over a 4½year period demonstrates that laparoscopic liver surgery is safe and effective in experienced hands for major resections An intimate knowledge of the technology and techniques available for preventing and managing significant hemorrhage during laparoscopic liver resection is required for all surgeons performing laparoscopic liver surgery
Keywords: