Totally Laparoscopic an atomical Liver Resections. Surgical Results.

Jose Galindo, MD, Fabrizio Moisan, MD, Juan F Guerra, MD, Marcel Sanhueza, MD, Jorge Martinez, MD, Nicolas Jarufe, MD

Pontificia Universidad Catolica de Chile

Introduction: The laparoscopic approach has become a safe alternative for liver resections. Its advantages include reduced morbidity, postoperative pain, postoperative recovery and shorter hospital stay.

Aim: To report the results of liver resections performed by total laparoscopic approach at our institution.

Methods: Non-concurrent cohort study. Data collection included review of the hepatobiliary database and clinical records of patients who underwent totally laparoscopic liver resection between August 2004 and June 2012. Results are expressed as percentages, medians and ranges.

Results: The series comprises 40 patients, with 67.5% of females. The median age was 47 [16-78] years. Nineteen lateral segmentectomies, 6 right hepatectomies, 5 resections of segments IVb and V, 4 left hepatectomies, 4 unisegmental resections, 1 resection of segments VI-VII and 1 resection of segments V-VI-VII were performed. In 23 patients (57.5%) the surgery was performed because of benign disease (6 hemangiomas, 6 intrahepatic lithiasis, 3 focal nodular hyperplasias, 2 hydatid cysts, 2 living donors and 4 others) and in 17 patients (42.5%) due to malignancy (6 hepatocarcinomas, 5 gallbladder cancer, 2 colorectal cancer metastasis, 2 breast cancer metastasis, 1 cholangiocarcinoma and 1 lymphoma). A total of 8 patients (20%) had liver cirrhosis, of which 4 had portal hypertension. The median lesion size was 5.5 [0.8-13] cm. Median operative time was 180 [80-420] minutes. The median operative bleeding was 300 [100-3500] mL. Three patients required transfusions. Five patients were converted to conventional surgery (12.5%). Among postoperative complications, there were 2 biliary fistulas, 3 intraabdominal collections, 1 hematoma and 1 wound infection. No patients required reoperation. There was no perioperative mortality. The median postoperative hospital stay was 4 [2-12] days. Median follow-up was 32 [1-95] months. No late complications were observed.

Conclusion: In our center, totally laparoscopic liver resections represent a safe alternative in selected patients, with low intra and postoperative morbidity for benign and malignant pathologies.

Session: Poster Presentation

Program Number: P357