Background: Although the feasibility of laparoscopic liver resections has been demonstrated, a very few studies comparing the laparoscopic approach to open surgery have been published. The left lateral sectionectomy (resection of segments II and III) was the first formal liver resection performed by laparoscopy. We developed a laparoscopic procedure very similar to open surgery, with an initial control of vascular inflow and outflow. The portal pedicles of segments II and III are dissected and divided separately, and the left hepatic vein is controlled before parenchymal transection. This study aimed to compare laparoscopic (LLS) to open left lateral sectionectomy (OLS) performed with the same standardized technique.
Methods: From 1999 to 2006, 40 consecutive patients who underwent LLS were compared with 66 patients with OLS from our liver resection database. The two groups were well matched for age (LLS, 59±12; OLS, 61±9 years, p=0.44), gender, American Society of Anesthesiology (ASA) class, type and size of the tumor, and presence of underlying liver disease (cirrhosis: LLS, 24%; OLS, 26%). Chisquare or T-Test were used to compare the 2 groups (respectively Fisher exact test and Mann-Whitney U test when the validity conditions were not verified).
Results: 106 patients were analyzed: 40 in LLS and 66 in OLS group. No conversion to open surgery was needed in the LLS group. Pringle maneuver was used in 6 patients in OLS group and was never needed in LLS group. The operative time was shorter in LLSgroup (209 vs. 265 min; p=0.05). The blood loss and transfusion rates were lower during laparoscopy (102 vs. 433 ml, p=0.0001; transfusion: 0% vs. 9%, p=0.08). There was no statistically significant difference in postoperative complications; Nevertheless a trend was observed for pulmonary complications (LLS, 0%; OLS, 9%; p=0.08). The mean hospital stay was shorter for LLS patients (4.7 vs. 8.5 days; p=0.03).
Conclusion: The laparoscopic approach for left lateral sectionectomy was associated with shorter operative time, decreased blood loss, absence of specific complications and a shorter hospital stay. A statistical trend was also observed for lower pulmonary complications. Laparoscopy could be recommended for left lateral sectionectomy and should be considered as a routine approach to centers that have experience in laparoscopic liver surgery.
Program Number: P335