Experiences of Laparoscopic Liver Resection for Liver Tumors in Pediatric Patients: Initial 11 cases

Jung-Man Namgoong, MD, Dae-Yeon Kim, MD, PhD, Seong-Chul Kim, MD, PhD, Ki-Hun Kim, MD, PhD, Ji-Hee Hwang, MD. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Purpose: The value of laparoscopic hepatectomy in children is not established. The aim of this study was to evaluate the outcome of laparoscopic hepatectomy in children with liver tumors.

Methods: This was a retrospective clinical study of 11 patients under the age of 18 years old who underwent laparoscopic hepatectomy for liver tumors between January 2008 and December 2012. The laparoscopic procedure was performed using three to five ports via laparoscopic via Cavitron Ultrasonic Surgical Aspirator (CUSA EXcelTM; Valleylab, Boulder, Colorado, USA) and ultrasonic shears (Harmonic scalpelTM; Ethicon Endosurgery, Cincinnati, USA). Because of the narrow abdominal cavity of pediatric patients, There were some points of difference in the location of trocars, the CO2 peumoperitoneum and the manipulation of laparoscopic CUSA comparing with laparoscopic hepatectomy in adult.

Results: The patient group comprised 6 females and 5 males, with a mean age of 49.2±60.4 months (range 0.3-180 months) and a mean body weight of 16.0±13.8 kg (range 3.8-50.0 kg). The diseases of patients were hepatoblastoma (n=6), focal nodular hyperplasia (n=3), recurred neuroblastoma (n=1), and liver abscess (n=1). Two patients underwent a major anatomical hepatic resection (right lobectomy); the others underwent minor hepatic resections (left lateral segmentectomy, IVb & V subsegmentectomies, segmentectomy, and right-sided non-anatomical resections). One patient required conversion to open procedure because of inadequate free surgical margins for focal nodular hyperplasia. Mean duration of operation was 195±75 minutes and mean duration of hospitalization was 7.0±2.0 days. There was no postoperative complication and perioperative mortality.

Conclusion: Laparoscopic hepatectomy requires extensive experiences in hepatobiliary and laparoscopic surgery, and a limited number of cases provide insufficient opportunities for pediatric surgeons to master the surgical procedure in pediatric population. Laparoscopic hepatectomy, nevertheless, offers many advantages, as widely published. The authors performed laparoscopic hepatectomies for benign and malignant liver tumors with respectability. Laparoscopic hepatectomy, therefore, would be a safe and feasible option for liver tumors in children. Randomized studies will be required in the future to establish laparoscopic hepatectomy as the standard procedure for liver tumor in pediatric patients. Key words: Laparoscopic hepatectomy, laparoscopic liver resection, pediatric patient, children, hepatoblastoma.

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