Comparison of Resection Techniques in Laparoscopic Hepatectomy

Koray Karabulut, MD, Federico Aucejo, MD, John Fung, MD PhD, Eren Berber, MD. Department of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA. Department of Hepato-Pancreato-Biliary and Transplant Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.

Background: Precoagulation using radiofrequency (RF) has been advocated to decrease blood loss in laparoscopic liver resection. We previously reported on the techniques of RF-precoagulation. The aim of this study is to compare RF-precoagulation with other resectional techniques regarding perioperative outcomes.
Methods: Between 1997 and 2010, 75 patients underwent laparoscopic liver resection in a single academic institution. Different tools were used for resection based on surgeon-preference, including RF-precoagulation, staplers or Harmonic scalpel and Tissue-Link. Patient demographics, tumor characteristics, types of resection and technique, perioperative outcome and follow up data were analyzed from a prospective IRB-approved database. Statistical analyses were performed using student t-test and Kaplan Meier survival. All data are expressed as mean ± SEM.
Results: Mean age was 60.2 ± 1.6 years. There were 26 (35%) men and 49 (65%) women. The resections performed for primary or metastatic malign liver lesions in 48 (64%) and for benign disease in 27 (36%) patients. Mean tumor size and number of tumors were 4.3 ± 0.4 cm and 1.3 ± 0.1, respectively. The procedure was laparoscopic in 46 patients (60%), robotic in 10 (14%), hand-assisted in 14 (19%) and hybrid in 5 (7%) patients. The resection type was wedge resection or segmentectomy in 45 (59%) patients, bisegmentectomy in 25 (34%) patients and hemihepatectomy in 5 (7%) patients. Resections were performed with RF-precoagulation in 37 patients (49%) and without in 38 patients (51%). The rate of conversion to open was 4% (3 patients). Overall estimated blood loss (EBL) was 119 ± 27 ml, operative time 215 ± 14 minutes, and length of stay (LOS) 3.2 ± 0.2 days. Morbidity was seen in 5 patients (7%) with no mortality. Resection margin for malignant tumors was 7 ± 2 mm. With a median follow up of 16 months, Kaplan Meier median disease-free survival was 14.5 months for these patients. Local recurrence was seen in 2 patients (3%). There was no statistical difference in EBL, operative time, complications, LOS or local tumor recurrence between patients who underwent resection with or without RF-precoagulation.
Conclusions: The limitation of the study is that selection of a given technique was surgeon-dependent. Within this limitation, the study shows that different hepatectomy techniques yield equivalent outcomes when used by experienced surgeons.


Session: Poster
Program Number: P394
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