Laparoscopic Systematic Liver Resections: From Hybrid to Pure

Go Wakabayashi, MD PhD, Hiroyuki Nitta, MD PhD, Akira Sasaki, MD PhD. Department of Surgery, Iwate Medical University School of Medicine

Background: Recent developments in liver surgery include the introduction of laparoscopic liver resection. Systematic liver resection appears to be superior to non-anatomical liver resection in operative and oncological results. World review of 2,804 laparoscopic liver resection revealed that only 43% was anatomical resections. The aim of the present study was to describe the procedure of laparoscopic systematic liver resection and to review a single institution’s experience of laparoscopic liver resection (LLR) including pure/totally laparoscopic liver resection (TLLR), hybrid/laparoscopy-assisted liver resection (LALR), and laparoscopy-assisted live donor liver resection (LALDLR). 
Methods: Systematic liver resection was performed by Glissonian approach either with hybrid or pure technique. Between May 1997 and December 2010, 212 patients underwent LLR for hepatocellular carcinoma (HCC) (75 patients), liver metastases (92), cholangiocellular carcinoma (CCC) (3), carcinoid (1), benign liver lesions (16), and living donor (25). Operations included 119 TLLR (96 wedge resections, 17 left lateral sectionectomies, 4 major anatomical hepatectomy, two S5 subsegmentectomy), 93 LALR (2 right trisectionectomy, 16 right hepatectomy, 17 left hepatectomy, 3 central bisectionectomy, 5 right anterior sectionectomy, 8 extended right posterior sectionectomy, and others), and 25 LALDLR (18 right hepatectomy, 6 left hepatectomy, one left lateral sectionectomy). Nineteen percent of TLLR, 100% of LALR/LALDLR, and 67% (141/212) in total, were systematic liver resection. 
Results: Median operating time was 161, 324, 375 min and blood loss 57, 546, 227 ml for TLLR, LALR, LALDLR, respectively. One TLLR was converted to a LALR. Only ten patients (4.7%) experienced postoperative complications, 4 patients (1.9%) showed bile leakage, and 6 patients (2.8%) developed wound infections.
Conclusions: Laparoscopic systematic liver resection can be performed safely for a variety of primary, secondary liver tumors, and even for live donors. Procedures vary from hybrid to pure technique and seem to offer at least short-term benefits in selected patients. Hybrid technique plays a role as a bridge to pure laparoscopic systematic liver resection during the learning curve period.

Session: Emerging Technology Poster
Program Number: ETP017
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