Laparoscopic Liver Resection: Lessons Learned From the First 105 Cases

Alejandro Mejia, MD, Tiffany Anthony, MD, Stephen S Cheng, MD. The Liver Institute at Methodist Dallas

INTRODUCTION

Laparoscopic Liver Resection (LLR) has become a routine part of HPB surgery. As the techniques evolve and more cases are done at different types of institutions, it is important to understand the indications, outcomes and limitations of these complex laparoscopic surgeries. Our aim with this study is to describe the experience with LLR at a non-university hospital.

Patients and Methods

A retrospective analysis of prospectively collected data was performed. The database was created after the first LLR was performed in June 2005 by The Liver Institute at Methodist Dallas. All cases have been performed by the authors and the technique has routinely included intraoperative US, a precoagulation technique for parenchymal transection and the use of endo-staplers. Specific analysis regarding a hand-assisted techniques (HA) vs full laparoscopic procedures (Lap) was performed. Individual variables were also analyzed for the cirrhotic patients.

Results

In the period between 6/05 – 9/10 a total of 105 LLR procedures were performed by a single team in the same hospital. Patients median age was 55 years (range 18-82); 62 were females and 43 males (p=0.06).Indications for resection were bening lesions in 57% and malignant lesions in 43% ( HCC was 31%)( p= NS).Cirrhosis was present in 25% of cases. EBL was significantly more in cirrhotics vs non-cirrhotics (306 vs 209 cc; p=0.04).
Table 1 shows clinical differences between the cases done with HA vs Lap techniques.

Overall complication rate was 13% and more frequent in cirrhotic patients including: 2 conversions to open,2 bowel obstructions,3 bile leaks,3 perihepatic abscesses,1 subacute liver decompensation,1 pneumothorax,1 DKA,1 postop A-fib.

Conclusions

LLR has been successfully applied to our centers’ routine clinical HPB practice. The use of a HA technique should be considered for cirrhotics, full lobectomies and as a quick salvage maneuver for bleeding control and when margin status is a concern. We have reserved the LLR for cirrhotics with good liver reserve (child’s A) and with unifocal lesions. In benign lesions, the full laparoscopic approach minimizes the hospital stay.

Despite the minimally invasive approach, LLR remains a major abdominal operation that requires caution in patient selection and a combination of laparoscopic and HPB surgical skills.