feasibility and safety of laparoscopic liver resections

Objective: To assess the feasibility and safety of laparoscopic liver resections

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Methods: A prospective study of laparoscopic liver resections was undertaken in San_camillo hospital, Rome Italy, Anam hospital, Seoul South Korea and Assiut University Hospitals. in the period from July, 2012 till, Augest 2014 in patients with preoperative diagnoses including benign lesion, hepatocellular carcinoma with compensated cirrhosis, and metastasis of colorectal and noncolorectal origin, the tumor had to be 5 cm or smaller. Surgical technique included CO2 pneumoperitoneum and liver transection with a harmonic scalpel, with without portal triad clamping or hepatic vein control. Portal pedicles and large hepatic veins were led. Resected specimens were placed in a bag and removed through a separate incision, without fragmentation

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Results: From July 2012 to Augest 2014 undertaken in San_camillo hospital, Rome Italy, hospital, Seoul South Korea and Assiut University Hospitals. 80 liver resections were included. Median follow up was 19 months ranging from 6 to 24 months. There were hepatocellular carcinoma [HCC; n=32], colorectal carcinoma liver metastasis [CRCLM; n=19] metastatic neuroendocrine tumor [NET;n=1], non-CRCLM [n=6], intrahepatic cholangiocarcinoma [n=4], lymphomas [n=1] and uncertain preoperative diagnosis [n=1] mostly pseudo inflammatory tumour, Mean tumor size was 3.6 cm. There were three conversions to laparotomy [3. 75%]. There were anatomical liver resection [n=31]. Four major hepatectomies [5%] were performed [3 segments or more], including 1 right hepatectomy and 3 left hepatectomies, 2 of them with caudate lobectomy. Mean blood loss was 129.50 mL. Mean surgical time was 115.36 minutes. There were no deaths. Complications occurred in 4 cases [5%]. two cirrhotic patients developed postoperative ascites. No port-site metastases were observed in patients with malignant disease

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Conclusion: Laparoscopic resections are feasible and safe in selected patients with left-sided and right-peripheral lesions requiring limited resection. Young patients with benign disease clearly benefit from avoiding a major abdominal incision, and cirrhotic patients may have a reduced complication rate. For liver resections, unlike other areas of abdominal surgery, the laparoscopic approach has not been widely developed. The reasons are presumed technical difficulties and the intraoperative hazards of bleeding and gas embolism. Another concern is the potential risk of tumor seeding in patients with malignant disease, who constitute the majority of candidates for liver resections. However, technologic refinements in laparoscopic instruments, experience in laparoscopic and hepatic surgery, and the application of the principles of oncologic surgery have led some groups, to explore the place of laparoscopic liver resections. Initial laparoscopic procedures on the liver included staging of tumors to select patients for open resection [Rahusen F, et al 1999] and treatment of nonparasitic cysts by unroofing. [Morino M,et al 1994] More recently, there have been advancement of laparoscopic liver resections up to living donor hepatectomy for liver transplantation. [Quirino Lai, et al 2012] We initiated a prospective evaluation of laparoscopic liver resections in selected patients, and we report the results in our first 80 patients]