Resección hepática laparoscópica versus hepatectomía abierta para lesiones benignas: estudio comparativo con propensity score matching / Laparoscopic liver resection versus open liver resection for benign lesions: a comparative study with propensity score matching

RESUMEN Antecedentes : las ventajas de la hepatectomía videolaparoscópica (HVL) hicieron que gane cada vez más campo para el tratamiento de los tumores hepáticos benignos (THB). Objetivo : comparar los resultados perioperatorios de pacientes sometidos a HVL con los de los operados con hepatectomía abierta (HA) por THB, emparejados con propensity score matching (PSM). Material y métodos : estudio descriptivo, retrospectivo y comparativo de HA y HVL por THB entre agosto de 2010 y junio de 2021. Se analizaron variables demográficas, preoperatorias, intraoperatorias y posoperatorias. Para evitar sesgos de las distintas covariables entre los grupos se realizó un PSM 1:1. Resultados : de 403 hepatectomías, se analizaron 82 por THB. De ellas 36 (44%) fueron HA y 46 (56%) HVL. Edad media 45 ±14 años, 65% mujeres. Tras realizar el PSM, quedaron dos grupos de 28 pacientes cada uno. En HA, 5 (18%) pacientes requirieron transfusiones y ninguno en HVL (p = 0,01). Las complicaciones mayores se presentaron en 4 (14%) pacientes en HA, y ninguna en HVL (p = 0,03). Se reoperaron 4 (14%) pacientes con HA y ningún paciente con HVL (p = 0,03). La estadía hospitalaria total fue significativamente mayor en las HA (p = 0,04). No se registraron muertes a los 90 días en ninguno de los dos grupos. Conclusión : la HVL por THB es una técnica segura y eficaz, ya que los pacientes presentaron menor requerimiento transfusional, número de reoperaciones, de complicaciones mayores y de estadía hospitalaria que con HA. Por las ventajas encontradas, la HVL podría ser considerada la técnica de elección en cirugía por THB.

ABSTRACT Background : The advantages of laparoscopic liver resection (LLR) have increased its use for the treatment of benign liver tumors (BLTs). Objective : The aim of this study was to compare the perioperative outcomes of patients undergoing LLR with those operated on with open liver resection (OLR) for BLTs using propensity score matching (PSM). Material and methods : We conducted a descriptive and retrospective study comparing OLRs with LLRs performed between August 2010 and June 2021. The demographic, perioperative, intraoperative and postoperative variables were analyzed. We used PSM with 1:1 matching to avoid biases of the different covariates between the groups. Results : Of 303 liver resections, 82 corresponded to BLTs and were included in the analysis; 36 (44%) were OLRs and 46 (56%) were LLRs. Mean age was 45 ±14 years and 65% were women. After PSM, two groups of 28 patients each were constituted. Five patients (18%) in the OLR group and none in the LLR required transfusions (p = 0.01). Major complications, occurred in 4 (14%) patients in the OLR group and in no cases in the LLR group (p = 0.03). Four (14%) undergoing OLR required reoperation versus no patients with LLR (p = 0.03). Total length of hospital stay was significantly longer in OLR (p = 0.04). There were no deaths in any of the groups within 90 days. Conclusion : LLR for BLTs is a safe and effective technique, with lower requirement for transfusions, fewer reoperations and major complications and shorter length of hospital stay than OLR, Therefore, LLR could be considered the surgical technique of choice for BLTs.

Efficacy and safety of laparoscopic surgery in treatment of recurrent hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To study the efficacy and safety of laparoscopic surgery in treatment of recurrent hepatocellular carcinoma.Methods:The clinical data of 58 patients with recurrent hepatocellular carcinoma who underwent surgical treatment from January 2010 to January 2018 at Hunan Provincial People’s Hospital were retrospectively analyzed. There were 50 males and 8 females, ranging in age from 28 to 78 (53.0±10.8) years old. Patients were divided into laparoscopic group ( n=27) and laparotomy group ( n=31) according to different surgical procedures. The differences in operative time, intraoperative blood loss, hospital stay, postoperative anal exhaustion time, postoperative complications and prognosis between the two groups were compared. Results:The intraoperative blood loss of laparoscopy group and laparotomy group were 100.0(50.0, 400.0) ml vs 300.0(100.0, 500.0) ml, the postoperative anal exhaustion time were (2.7±0.6) d vs (3.3±0.6) d, the hospital stay were (14.8±3.8) d vs (21.4±6.3) d, and these differences were statistically significant (all P<0.05). The operative time of the two groups were (243.4±27.2) min vs (217.5±34.7) min, with no statistical significance ( t=0.59, P=0.344). There were no significant differences between the two groups in postoperative complications (bile leakage, abdominal infection, hemorrhage, pleural effusion and hepatic encephalopathy) (all P>0.05); thetumor free survival, 1-year, and 3-year overall survival rates of the two groups were also not significantly different (both P>0.05). Conclusion:Laparoscopic surgery is safe and effective in the treatment of recurrent hepatocellular carcinoma, and its prognosis is similar to laparotomy, its complications are not significantly increased, which is worthy of promotion in clinic.

Radiofrequency ablation versus laparoscopic hepatectomy for hepatocellular carcinoma: a Meta-analysis / 中华肝胆外科杂志

Objective:To compare the effectiveness and safety of laparoscopic hepatectomy (LH) versus radiofrequency ablation (RFA) in treatment of hepatocellular carcinoma (HCC).Methods:The medical literatures on LH and RFA for HCC were searched in PubMed, Web of Science, Embase, VIP, Wanfang, CNKI and other electronic databases. The retrieval date was from database construction to June 7, 2021. According to the inclusion and exclusion criteria, studies were extracted by two authors, and Revman 5.3 software was used to conduct a meta-analysis to compare differences in operation time, blood loss, length of hospital stay, total complications, overall survival and disease-free survival outcomes between the LH group and the RFA group.Results:Of 3 690 patients who were included in 32 studies, there were 1 708 patients in the LH group and 1982 patients in the RFA group. Meta-analysis showed that compared with the LH group, the RFA group had significantly shorter surgical duration ( MD=-86.41, 95% CI: -116.21--56.60), less blood loss ( MD=-213.22, 95% CI: -273.43--153.00), shorter hospital stay ( MD=-3.23, 95% CI: -4.13--2.32), and lower incidence of complications ( OR=0.33, 95% CI: 0.26-0.43). However, local recurrence rate was significantly higher ( OR=1.83, 95% CI: 1.38-2.41). (All P<0.05). The 5-year survival rate of the LH group was significantly better than the RFA group ( OR=0.68, 95% CI: 0.51-0.90, P=0.008). Conclusion:LH provided better overall survival outcomes and lower local recurrence rates than RFA in HCC patients.

Experiencia inicial en hepatectomías videolaparoscópicas / Initial experience in laparoscopic liver resections

RESUMEN Antecedentes: La cirugía hepática videolaparoscópica ha experimentado un importante desarrollo; sin embargo, la mayoría de las hepatectomías continúan haciéndose por vía convencional. Objetivo: presentar la experiencia y aplicabilidad de hepatectomías videolaparoscópicas. Material y métodos: análisis retrospectivo de pacientes sometidos a una hepatectomía entre agosto de 2010 y diciembre de 2019. Analizamos variables preoperatorias, intraoperatorias y posoperatorias. Para evaluar la aplicabilidad, se dividió la muestra en: Etapa 1: agosto de 2010 a diciembre de 2013; Etapa 2: enero de 2014 a diciembre de 2016, Etapa 3: enero de 2017 a diciembre de 2019. Resultados: de 385 hepatectomías realizadas, 119 fueron videolaparoscópicas: 53 (44%) fueron to talmente laparoscópicas, 64 (54%) mano-asistidas y 2 híbridas. La aplicabilidad global fue 31%. En la etapa 1: 23% , en la 2: 30% y en la 3: 44% (p < 0,05). Fueron patología maligna en la etapa 1: 36%, en la 2: 67% y en la 3: 72% (p < 0,05). Hepatectomías mayores: 13%, 31% y 32% en etapas 1, 2, y 3, respectivamente (p < 0,05). El índice de conversión fue 12%, 0% y 11%, respectivamente (p NS). Se utilizó clampeo pedicular en: 6%, 5% y 45%; (p < 0,05). Las complicaciones en la etapa 1 fueron 30%, en la 2: 28% y en la 3: 17%, siendo complicaciones Dindo-Clavien III o más, el 6%, 13% y 5%, respectivamente, p NS. Conclusiones: Aa pesar de su complejidad, las hepatectomías videolaparoscópicas son técnicamente reproducibles. Adquiriendo experiencia, podemos aumentar la aplicabilidad, a favor de la patología oncológica y complejidad, sin comprometer la seguridad del paciente.

ABSTRACT Background: Despite laparoscopic liver resection has significantly evolved, most hepatectomies are performed by the conventional approach. Objective: The aim of this study is to present the initial experience and applicability of laparoscopic liver resections. Material and methods: We conducted a retrospective analysis of patients undergoing liver resection between August 2010 and December 2019. Perioperative, intraoperative and postoperative variables were analyzed. To evaluate applicability, the sample was divided into 3 stages: stage 1, from August 2010 to December 2013; stage 2, from January 2014 to December 2016; and stage 3, from January 2017 to December 2019. Results: Of 385 liver resections performed, 119 were laparoscopic procedures: 53 (44%) were pure laparoscopic procedures, 64 (54%) were hand-assisted (64 patients) and 2 corresponded to hybrid procedures. Global applicability was 31%. In stage 1 1: 23%, in 2: 30% and in 3: 44% (p < 0.05). Malignant lesions: stage 1: 36%, stage 2: 67% and stage 3: 72% (p < 0.05). Major liver resections: 13%, 31% and 32% in stages 1, 2, and 3, respectively (p < 0.05). Conversion rate was 12%, 0% and 11%, respectively (p NS). Hepatic pedicle clamping was used in 6%, 5% and 45%; (p < 0.05). Complications in stage 1 were 30%, in stage 2: 28% and in stage 3: 17%, and Clavien-Dindo complications grade 3 or greater were 6%, 13% and 5%, respectively, p NS. Conclusions: Laparoscopic liver resections are complex procedures but technically reproducible. Applicability increases with the acquisition of experience, not only in malignant lesions but also in complex lesions ensuring safety for the patient.

Resultados de la resección hepática laparoscópica en el Hospital Metropolitano / Results of laparoscopic liver resection in the Metropolitan Hospital

Objetivo: evaluar los resultados perioperatorios de las resecciones hepáticas por abordaje laparoscópico, su seguridad y eficacia. Materiales y métodos: estudio epidemiológico descriptivo retrospectivo de serie de casos en el Hospital Metropolitano, en el cual se incluyó a todos los pacientes a quienes se realizó resecciones hepáticas laparoscópicas, durante un período de 10 años. Las variables recogidas se agruparon de la siguiente manera: I. Variables de los datos generales (edad, sexo, comorbilidades), II. Variables de diagnóstico prequirúrgico y cirugía, III. Variables de resultados intraoperatorios y posquirúrgico (pérdida de sangre, complicaciones, tiempo quirúrgico, etcétera). Resultados: de 10 pacientes identificados, 8 fueron de sexo femenino y 2 de sexo masculino, edad promedio: 46,8 años, 60% no presentó comorbilidades, estancia hospitalaria promedio: 5,3 días, tiempo quirúrgico promedio: 211 minutos, diagnóstico prequirúrgico más frecuente: hemangioma; sin embargo, en el histopatológico predominó la hiperplasia nodular focal en un 30%, y la patología maligna se observó en el 50% de los casos, de los cuales no hubo márgenes comprometidos; se presentó aproximadamente 20% de complicaciones posquirúrgicas de las cuales las más frecuentes fueron el sangrado y las trasfusiones. Conclusiones: la hepatectomía laparoscópica es una técnica segura y efectiva con baja morbilidad, además de las ventajas de la cirugía laparoscópica.

Objective: To evaluate the perioperative results of liver resections by laparoscopic approach, their safety and efficacy. Methods: A retrospective descriptive epidemiological study of a series of cases at the Hospital Metropolitano, including all patients who undergo laparoscopic liver resections. The variables collected are grouped as follows: I. Variables of the general data (age, sex, comorbidities), II. Pre-surgical diagnosis and surgery variables, III. Variables of intraoperative and postoperative results (blood loss, complications, surgical time, etc). Results: Of 10 identified patients, 8 were women and 2 were male, with an average age of 46.8 years, 60% without comorbidities, hospital stay with an average of 5.3 days, average surgical time of 211 minutes, the most frequent presurgical diagnosis was hemangioma however, in the histopathology, focal nodular hyperplasia predominated in 30%, and malignant pathology was detected in 50% of cases, of which there were no compromised margins, and 20% of complications were found among them more frequent bleeding and transfusions. Conclusions: Laparoscopic hepatectomy is a safe and effective technique with low morbidity in addition to having the advantages of laparoscopic surgery.

Application of augmented-reality surgical navigation technology combined with ICG molecular fluorescence imaging in laparoscopic hepatectomy / 中华外科杂志

Objective@#To study the application value of augmented-reality (AR) surgical navigation technology combined with indocyanine green (ICG) molecular fluorescence imaging in three-dimensional (3D) laparoscopic hepatectomy.@*Methods@#The clinical data of forty-eight patients who had undergone 3D laparoscopic hepatectomy for hepatocellular carcinoma at First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University from January 2018 to April 2019 were retrospectively analyzed.The patients were divided into two groups: the group of 3D laparoscopic hepatectomy navigated by augment reality technology combined with ICG molecular fluorescence imaging (Group A) , and group of conventional 3D laparoscopic hepatectomy (Group B) . Patients in Group A (n=23) underwent 3D laparoscopic hepatectomy using augmented-reality technology combined with ICG molecular fluorescence imaging. In this group, the self-developed three-dimensional laparoscopic augmented-reality surgical navigation system (No. 2018SR840555) was operated to project the preoperative three-dimensional model to the surgical field, and the use of this system in combination with ICG molecular fluorescence imaging navigated laparoscopic hepatectomy. No surgical navigation technology was applied in Group B (n=25) . All patients signed the informed consent, which were in accordance with the requirements of medical ethics (Ethics No.: 2018-GDYK-003) . The preoperative data, surgical indicators and postoperative complications between the two groups were compared and analyzed.@*Results@#The median amount of intraoperative blood loss of Group A was 250 (200) ml (M (QR) ) , which was significantly lower than that of Group B (300 (150) ml) (Z=-2.307, P=0.021) .The transfusion rate of Group A was 13.0% (3/23) , which was significantly lower than that of Group B (40.0%, 10/25) (χ2=4.408, P=0.036) .The median postoperative hospitalization time of Group A was 8 (2) d, which was significantly shorter than that of Group B (11 (6.5) d) (Z=-2.694, P=0.007) . There were no serious complications and perioperative death in both groups.The incidence of postoperative complications in Group A was 17.4% (4/23) , which was not significantly different from that in group B (28%, 7/25) (χ2=0.763, P=0.382) .@*Conclusion@#Augmented-reality surgical navigation technology combined with ICG molecular fluorescence imaging has better effect in 3D laparoscopic hepatectomy.

Treatment of CO2 embolism in laparoscopic hepatectomy / 中华肝胆外科杂志

Objective To study the diagnosis and treatment of CO2 embolism in laparoscopic hepatectomy (LH).Methods A retrospective study was conducted on 80 patients who underwent various types of LH from June 2016 to November 2017.The clinical data of 4 patients who suffered from severe CO2 embolism were analyzed.Results The operation time of 80 patients varied from 65 min to 345 min (average 170 min).Tbe amount of blood loss ranged from 50 ml to 2 500 ml (average 450 ml).28 patients (35％) required blood transfusion.Two patients were converted to open operation because of uncontrollable bleeding.Four patients suffered from severe CO2 embolism with significant changes in circulation and respiration.After active and effective treatment,none required open conversion and all recovered well.Conclusions Any sudden respiratory and circulatory changes during LH should lead us to think of severe CO2 embolism.Timely and effective treatment could convert a dangerous situation to become safe.

Intercostal trocars and transthoracic trocars facilitated laparoscopic resection of lesions in liver segments 7 and 8 : a report of 20 cases / 中华肝胆外科杂志

Objective To evaluate the use of intercostal trocars (ICS) and transthoracic trocars in laparoscopic resection of liver segments 7 and 8.Method From November 2015 to June 2017,20 patients who underwent laparoscopic S7 or 8 segmentectomy for liver tumors in the Department of Hepatobiliary Surgery,the First Affiliated Hospital,Guangxi Medical University were analyzed retrospectively.Results Ports were inserted at the 8th or 9th ICS,respectively,in addition to the conventional abdominal ports.The mean operation time was 225.0 min (110.0 ～ 486.0 min).Anatomical resection was completed in 1 patient,and non-anatomical resection in 19 patients.The conversion rate was 0％.Pringle's maneuver was used in 9 patients.The mean blood loss was 85.0 (25.0 ～410.0) ml,and the mean length of hospital stay was 7.0 (5.0 ～ 12.0) days.The complication rate was 10.0％.Pathologic findings revealed that 17,2,1 patient(s) had HCC,hemangioma,and inflammatory nodule,respectively.The mean tumor size and tumor free margin were 33.8 (15.0 ～ 74.0) mm;and 15.0 (1.0 ～ 30.0) mm,respectively.There was no HCC recurrence on follow-up,expect for one patient who developed tumor recurrence at 20 months after laparoscopic liver resection.Conclusions In selected patients,laparoscopic liver resection using intercostal trocars was useful and safe for tumors located in liver segments 7 and 8.The long-term oncologic outcomes need to be further evaluated.

The causes and management of carbon dioxide embolism in laparoscopic hepatectomy / 中华肝胆外科杂志

Objective To investigate the strategies in dealing with intraoperative CO2 embolizm during Laparoscopic hepatectomy (LH).Methods We collected and analyzed data from patients who underwent laparoscopic hepatectomy (LH) in our hospital from Jan.2013 to Aug.2017.There were 321 patients.The criteria for the diagnosis of CO2 embolism were rapid intraoperative decrease in petCO2 and SPO2 accompanied with tachyarrhythmia.Results 12 patients were diagnosed to have CO2 embolism.The rate was 3.7％.For these 12 patients,10 patients were dealt with laparoscopically and 2 patients were converted to open surgery.Conclusion CO2 embolism did not rarely occur in LH patients.Sophisticated operations and careful manipulation in LH are the only ways to prevent CO2 embolism.

Pure laparoscopic right hemihepatectomy for hepatocellular carcinoma via the anterior approach / 中华肝胆外科杂志

Objective To study the feasibility and safety of pure laparoscopic right hemihepatectomy for hepatocellular carcinoma via the anterior approach.Methods The data of five patients with hepatocellular carcinoma who underwent pure laparoscopic right hemihepatectomy at the First People's Hospital of Foshan between December 2013 and December 2016 were retrospectively analyzed.Patients'operation time,blood loss,blood transfusion rate,surgical margins,hospital stay,complication and short term outcomes were reviewed.Results All the five patients completed pure laparoscopic right hemihepatectomy without conversion to open surgery.The average (range) operation time was 6.0 (5 ～ 8) h.The average blood loss was 340 (110 ～ 600) ml.No patient received blood transfusion.The average surgical margin was 2.4 (1 ～4.5) cm.The average postoperative hospital stay was 7 (4 ～ 15) d.The average follow-up was 22 (2 ～38) months.Three patients experienced postoperative complications,which included ascites,pleural effusion,and ascites accompanied by biliary leakage,respectively.The last patient recovered well from drainage.No liver failure,cancer recurrence or death was noted.Conclusions This study demonstrated that pure laparoscopic right hemihepatotectomy via the anterior approach is a minimally invasive procedure which has the advantage of fast postoperative recovery.It was feasible and safe to treat hepatocellular carcinoma with favorable short-term outcomes.

Evolution of laparoscopic liver resection at Singapore General Hospital: a nine-year experience of 195 consecutive resections

<p><b>INTRODUCTION</b>We aimed to analyse the changing trends, safety and outcomes associated with the adoption of laparoscopic liver resection (LLR) at a single centre.</p><p><b>METHODS</b>A retrospective review of patients who underwent LLR from 2006 to 2014 at our institution was performed. To explore the evolution of LLR, the study was divided into three equal consecutive time periods (Period 1: 2006-2008, Period 2: 2009-2011, and Period 3: 2012-2014).</p><p><b>RESULTS</b>Among 195 patients who underwent LLR, 24 (12.3%) required open conversions, 68 (34.9%) had resection of tumours in the difficult posterosuperior segments and 12 (6.2%) underwent major (≥ 3 segments) hepatectomies. Median operation time was 210 (range 40-620) minutes and median postoperative stay was 4 (range 1-26) days. Major postoperative morbidity (> Grade II) occurred in 11 (5.6%) patients and 90-day/in-hospital mortality was 1 (0.5%). During the study, the number of LLRs performed showed an increasing trend (Period 1: n = 22; Period 2: n = 19; Period 3: n = 154). Other statistically significant trends were: (a) increase in malignant neoplasms resected; (b) increase in resections of difficult posterosuperior segments; (c) longer median operation time; and (d) decrease in open conversion rates.</p><p><b>CONCLUSION</b>Over the study period, the number of LLRs increased rapidly. LLR was increasingly performed for malignant neoplasms and lesions located in the difficult posterosuperior segments, resulting in longer operation times. However, open conversion rates decreased, and there was no change in postoperative morbidity and other perioperative outcomes.</p>

Impact of enhanced recovery after surgery on immune function in patients undergoing laparoscopic hepa-tectomy / 临床麻醉学杂志

Objective To investigate the impact of enhanced recovery after surgery (ERAS)on immune function in patients undergoing laparoscopic hepatectomy.Methods Sixty patients undergoing laparoscopic hepatectomy (34 males,26 females,aged 38-57 years,ASA Ⅰ or Ⅱ),were randomly divided into two groups:enhanced recovery after surgery group (group E)and non-enhanced recovery after surgery group (group C).The patients in group E received enhanced recovery after surgery,while the patients in group C received routine perioperative management and anesthesia methods.The operation method and time,the volume of bleeding,the intraoperative fentanyl con-sumption,the volume of fluid input,the preoperative and postoperative CVP and temperature were recorded in the two groups.Blood samples were obtained before induction (T0 ),at the end of opera-tion (T1 ),on day 1 (T2 ),day 3 (T3 ),day 7 (T4 )after operation for determination of plasma con-centration of IgA,IgM,IgG and the percentages of T lymphocyte subsets (CD3+ ,CD4+ ,CD8+ ) and CD4+/CD8+ ratio were detected with flow cytometry.Furthermore,the visual analogue scale (VAS)score and Ramsay score were evaluated 4 hours,8 hours,24 hours and 48 hours after opera-tion in two groups.Results Compared with group C,the intraoperative fentanyl consumption,the volume of fluid input and the postoperative CVP in group E were significantly decreased,while the postoperative temperature was significantly increased (P < 0.05 ).Compared with T0 , the percentages of CD3+ ,CD4+ ,the CD4+/CD8+ ratio and the plasma concentration of IgA,IgM,IgG in group E on T1-T3 were significantly decreased,the percentages of CD3+ ,CD4+ ,the CD4+/CD8+ratio and the plasma concentration of IgA,IgM,IgG in group C on T1-T4 were significantly decreased (P <0.05).Compared with group C,the percentages of CD3+ ,CD4+ ,the CD4+/CD8+ ratio and the plasma concentration of IgA,IgM,IgG in group E on T1-T4 were significantly increased (P <0.05),the visual analogue scale (VAS)score 4 hours,8 hours,24 hours after operation were signifi-cantly decreased (P <0.05).The comparision of Ramsay scores at all the time points between two groups were similar.Conclusion ERAS applied to patients undergoing laparoscopic hepatectomy can reduce the intraoperative fentanyl consumption,prevent the occurrence of hypothermia and provide satisfactory postoperative analgesia,which can significantly improve the immune function in patients.

Robotic hepatectomy: initial experience of a single institution in Singapore

<p><b>INTRODUCTION</b>In this study, we report our initial experience with robotic hepatectomy.</p><p><b>METHODS</b>Consecutive patients who underwent robotic hepatectomy at Singapore General Hospital, Singapore, from February 2013 to February 2015 were enrolled in this study. The difficulty level of operations was graded using a novel scoring system for laparoscopic hepatectomies.</p><p><b>RESULTS</b>During the two-year period, five consecutive robotic hepatectomies were performed (one left lateral sectionectomy, one non-anatomical segment II/III resection, one anatomical segment V resection with cholecystectomy, one extended right posterior sectionectomy and one non-anatomical segment V/VI resection). Two hepatectomies were performed for suspected hepatocellular carcinoma, two for solitary liver metastases and one for a large symptomatic haemangioma. The median age of the patients was 53 (range 38-66) years and the median tumour size was 2.5 (range 2.1-7.3) cm. The median total operation time was 340 (range 155-825) minutes and the median volume of blood loss was 300 (range 50-1,200) mL. There were no open conversions and no mortalities or major morbidities (> Clavien-Dindo Grade II). The difficulty level of the operations was graded as low in one case (Score 2), intermediate in three cases (Score 5, 6 and 6) and high in one case (Score 10). There was one minor morbidity, where the patient experienced Grade A bile leakage, which resolved spontaneously. The median length of postoperative hospital stay was 5 (range 4-7) days.</p><p><b>CONCLUSION</b>Our initial experience confirmed the feasibility and safety of robotic hepatectomy.</p>

Laparoscopic versus traditional open splenectomy for hepatocellular carcinoma with hypersplenism / 华中科技大学学报（医学）（英德文版）

This study aimed to examine the efficacy of the laparoscopic vs. traditional open splenectomy for hepatocellular carcinoma (HCC) with hypersplenism. Between 2002 and 2013, 51 Chinese HCC patients with hypersplenism underwent either simultaneous laparoscopic splenectomy plus anticancer therapies (Lap-S&A) (n=25) or traditional open splenectomy plus anti-cancer therapies (TOS&A) (n=26). The outcomes were reviewed during and after the operation. Anti-cancer therapies for HCC included laparoscopic hepatectomy (LH) and laparoscopic microwave ablation (LMA). The results showed that there was no significant difference in the operating time between the two groups, but the blood loss and blood transfusion were less, pain intensity after surgery was weaker, the time to first bowel movement, time to the first flatus and postoperative hospital stay were shorter, and the postoperative complication rate and the readmission rate were lower in the Lap-S&A group than in the TO-S&A group. Two patients in the Lap-S&A group and one patient in the TO-S&A group died 30 days after surgery. However, no significant difference in the mortality rate was noted between the two groups. It was concluded that simultaneous Lap-S&A holds the advantages of more extensive indications, lower complication incidence and less operative expenditure than conventional open approach and it is a feasible and safe approach for HCC with hypersplenism.

Analysis of the Short-term Result of Laparoscopic Liver Resection vs Open Liver Resection for Hepatocellular Carcinoma

PURPOSE: Laparoscopic surgery has recently shown rapid development, and has been applied in most abdominal surgeries. It has also been adopted in hepatobiliary surgery, especially in the resection of liver tumors. Significant advantages of laparosopic surgery over the conventional open method have been reported, however, the safety of the surgical resection margin and radicality of the tumor resection remain to be clarified. This study was conducted in order to assess the feasibility and potential superiority of laparoscopic liver resection of hepatocellular tumors to open surgery. METHODS: This study included 76 patients who underwent liver resection for hepatocellular carcinoma at Dong-A University Hospital from January 2008 through June 2010. Of these 63 cases, 31 patients underwent laparoscopic resections and 33 underwent open liver resections. Both groups were confirmed as hepatocellular carcinoma by postoperative pathology and analyzed retrospectively. RESULTS: There were no statistically significant differences in preoperative parameters, such as age, height, body weight, Child Pugh score, ASA, and tumor size in both groups. There were no significant differences in operating time, duration of hospital stay, safety margins of surgical resection, postoperative complications, and rate of recurrence and occurrence of new lesions in both groups, however, better disease free survival was observed in the laparoscopic group (p=0.024). CONCLUSION: Findings of this study showed that the laparoscopic group had better results in free survival period than the open group. Conduct of larger scale prospective studies wound confirm the superiority of the laparoscopic liver resection to the conventional open procedure in patients with hepatocellular carcinoma. Findings of this study also suggest that assessment of the factors associated with the quality of life, such as degree of postoperative pain, and size of the incisional scar, and long term postoperative complications may play an additional role in favoring the laparoscopic liver resection. To elucidate the superiority of the laparoscopic liver resection to the conventional open method, conduct of study involving a larger study group and a longer prospective research period will be needed.

Recent advance in laparoscopic hepatectomy / 中华肝胆外科杂志

Laparoscopic hepatectomy (LH) has been an incredible proliferation worldwide. many series have demonstrate that LH decreases intraoperative bleeding, postoperative compliceations and the duration of hospital stay. When compared with open hepatectomy(OP). Since the first LH was reported in 1992, near to 3000 cases have been reported,it's morbidity and mortality are 10. 5% and 0. 3% respectively. There are three terms should be used describe LH: pure laparoscopy, hand-assisted laparoscopy, and hybrid technique. In the beginning of LH, both resections were performed using the ultrasonic dissector and electrocautery,the operation included small wedge resection, liver cyst resection, and liver briopsy, however, while improvements in technology,as harmornic scalpel, endovasculer stapling devices, water jet, LigaSure, TissurLink, Habib etc. With increased experience, surgeons became holder and began to performe larger LH. But the keypoint of LH was use of portal inflow occlusion,and technique of paranchymal transection.

Surgical Clip Moved into the Extrahepatic Bile Duct after Laparoscopic Hepatectomy / 대한내시경복강경외과학회지

In the case of using surgical clips for division of the cystic duct during laparoscopiccholecystectomy, surgical clip migration into the common bile duct is known to be an extremely rare complication. However, its mechanism is currently unclear. The incidence of performing laparoscopic hepatectomy has significantly increased in the laparoscopic center of hospitals. Accordingly, the complications associated with using clips in laparoscopic cholecystectomy have increase as well. A 49 year-old female patient underwent laparoscopic left hepatectomy due to left intrahepatic duct stones with cholangitis. We report here on a case of a clip that migrated into the common bile duct and the duct had bile stones. We also review the relevant literature.

Progress of laparoscopic hepatectomy / 国际外科学杂志

Open hepatectomy(OH) is a effective treatment for benign and malignant liver lesions. However, OH has major abdominal trauma and many postoperative complications. How to reduce OH-induced trauma is still a big problem for liver surgeon. Fortunately, the emergence of laparoscope provides a route to solve this problem. But the technology of laparoscopic liver resection is not yet mature. This article reviews some relevant circumstances about laparoscopic hepatectomy.

The Feasibility of Laparoscopic Hepatectomy for the Patients with Left Intrahepatic Stones

PURPOSE: Recently, there have been several studies on the early results of hepatectomy for various intrahepatic lesions. We report the early experience of our hospital after total laparoscopic left hepatectomy in patients with intrahepatic stones in the left hemi-liver. METHODS: We retrospectively analyzed the medical records of patients who were diagnosed with left intrahepatic stones and underwent hepatectomy between January 2007 and June 2009. The patients were grouped according to operative procedure into open hepatectomy, laparoscopy-assisted hepatectomy, and total laparoscopic hepatectomy. RESULTS: There were 31 patients who underwent Lt hemihepatectomy and Lt lateral sectionectomy during this period. Hepatectomy with open method, laparoscopy-assisted method, and total laparoscopy method were performed in 10, 14, and 7 cases. There were no significant differences between the three methods for operating time and postoperative complications. But the number of fasting times and hospital days was shorter with total laparoscopic hepatectomy than with others. CONCLUSION: Total laparoscopic liver resection is a safe and useful method for treating patients with intrahepatic stones and offers the advantage of quick patient recovery. Careful selection of appropriate patients and further development in the laparoscopic surgical technique resulting from accumulated experiences will help enable the laparoscopic hepatectomy to be performed more easily and safely in patients with intrahepatic stones.

Laparoscopic left lateral hepatectomy: the first case at Thammasat University, Thailand

Background: A large incision of opened hepatectomy may cause many complications. Minimally invasive surgery of liver is challenging. Objective: To present the first case of a benign liver tumor, hemangioma, operated with a novel technique of laparoscopic hepatectomy in Thailand. Method: We report a 48-year-old female patient with chronic epigastric pain. A study of esophago-gastroduodenoscopy was normal. Ultrasound examination showed a mass of 6.5 cm in a left lobe of a liver. MRI and RBC scans showed hemangioma. Laparoscopic left lateral hepatectomy was performed. Result: Duration of the operation was 4 hours with approximately 300 cc of blood loss. Post-operative recovery was good. The patient could return home within 5 days after the operation. There were no complications. Conclusion: Laparoscopic left lateral hepatectomy for benign tumor case may be appropriate.