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      Complications of Liver Resection: Laparoscopic Versus Open Procedures

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          Abstract

          Complications appear to be lower in laparoscopic cases versus open cases for anterolateral and posterosuperior hepatic segment surgery.

          Abstract

          Background and Objective:

          Minimally invasive surgery for liver resection remains controversial. This study was designed to compare open versus laparoscopic surgical approaches to liver resection.

          Methods:

          We performed a single-center retrospective chart review.

          Results:

          We compared 45 laparoscopic liver resections with 17 open cases having equivalent resections based on anatomy and diagnosis. The overall complication rate was 25.8%. More open resection patients had complications (52.9% vs 15.5%, P < .008). The conversion rate was 11.1%. The mean blood loss was 667.1 ± 1450 mL in open cases versus 47.8 ± 89 mL in laparoscopic cases ( P < .0001). Measures of intravenous narcotic use, intensive care unit length of stay, and hospital length of stay all favored the laparoscopic group. Patients were more likely to have complications or morbidity in the open resection group than in the laparoscopic group for both the anterolateral ( P < .085) and posterosuperior ( P < .002) resection subgroups.

          Conclusion:

          In this series comparing laparoscopic and open liver resections, there were fewer complications, more rapid recovery, and lower morbidity in the laparoscopic group, even for those resections involving the posterosuperior segments of the liver.

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          Most cited references29

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          Laparoscopic liver resections: a feasibility study in 30 patients.

          F Stephan, R Hammoud, D Cherqui … (2000)
          To assess the feasibility and safety of laparoscopic liver resections. The use of the laparoscopic approach for liver resections has remained limited for technical reasons. Progress in laparoscopic procedures and the development of dedicated technology have made it possible to consider laparoscopic resection in selected patients. A prospective study of laparoscopic liver resections was undertaken in patients with preoperative diagnoses including benign lesion, hepatocellular carcinoma with compensated cirrhosis, and metastasis of noncolorectal origin. Hepatic involvement had to be limited and located in the left or peripheral right segments (segments 2-6), and the tumor had to be 5 cm or smaller. Surgical technique included CO2 pneumoperitoneum and liver transection with a harmonic scalpel, with or without portal triad clamping or hepatic vein control. Portal pedicles and large hepatic veins were stapled. Resected specimens were placed in a bag and removed through a separate incision, without fragmentation. From May 1996 to December 1999, 30 of 159 (19%) liver resections were included. There were 18 benign lesions and 12 malignant tumors, including 8 hepatocellular carcinomas in cirrhotic patients. Mean tumor size was 4.25 cm. There were two conversions to laparotomy (6.6%). The resections included 1 left hepatectomy, 8 bisegmentectomies (2 and 3), 9 segmentectomies, and 11 atypical resections. Mean blood loss was 300 mL. Mean surgical time was 214 minutes. There were no deaths. Complications occurred in six patients (20%). Only one cirrhotic patient developed postoperative ascites. No port-site metastases were observed in patients with malignant disease. Laparoscopic resections are feasible and safe in selected patients with left-sided and right-peripheral lesions requiring limited resection. Young patients with benign disease clearly benefit from avoiding a major abdominal incision, and cirrhotic patients may have a reduced complication rate.
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            Laparoscopic versus open hepatic resections for benign and malignant neoplasms--a meta-analysis.

            Ara Darzi, P P Tekkis, Richard Lovegrove … (2007)
            Laparoscopic surgery for hepatic neoplasms aims to provide curative resection while minimizing complications. The present study compared laparoscopic versus open surgery for patients with hepatic neoplasms with regard to short-term outcomes. Comparative studies published between 1998 and 2005 were included. Evaluated endpoints were operative, functional, and adverse events. A random-effects model was used and sensitivity analysis performed to account for bias in patient selection. Eight nonrandomized studies were included, reporting on 409 resections of hepatic neoplasms, of which 165 (40.3%) were laparoscopic and 244 (59.7%) were open. Operative blood loss (weighted mean difference = -123 mL; confidence interval = -179, -67 mL) and duration of hospital stay (weighted mean difference = -2.6 days; confidence interval = -3.8, -1.4 days) were significantly reduced after laparoscopic surgery. These findings remained consistent when considering studies matched for the presence of malignancy and segment resection. There was no difference in postoperative adverse events and extent of oncologic clearance. Laparoscopic resection results in reduced operative blood loss and earlier recovery with oncologic clearance comparable with open surgery. When performed by experienced surgeons in selected patients it may be a safe and feasible option. Because of the potential of significant bias arising from the included studies, further randomized controlled trials should be undertaken to confirm this bias and to assess long-term survival rates.
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              Laparoscopic anatomical (hepatic) left lateral segmentectomy-technical aspects.

              J Azagra, Marc Jacobs, Krista Goergen … (1996)
              Laparoscopic liver surgery is a tremendous challenge. The authors report a left liver lobectomy and removal by a total laparoscopic approach. Anatomical left lateral laparoscopic segmentectomy was performed on a woman who had a symptomatic hepatic adenoma. The patient was discharged after an uncomplicated postoperative recovery; the hospital stay and convalescence period were very short. The cosmetic result was good.
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                Author and article information

                Contributors
                :
                Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
                :
                Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
                :
                Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
                :
                Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
                :
                Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
                Journal
                Journal ID (nlm-ta): JSLS
                Journal ID (iso-abbrev): JSLS
                Journal ID (hwp): jsls
                Journal ID (pmc): jsls
                Journal ID (publisher-id): JSLS
                Title: JSLS : Journal of the Society of Laparoendoscopic Surgeons
                Publisher: Society of Laparoendoscopic Surgeons (Miami, FL )
                ISSN (Print): 1086-8089
                ISSN (Electronic): 1938-3797
                Publication date (Print): Jan-Mar 2013
                Volume: 17
                Issue: 1
                Pages: 46-55
                Affiliations
                Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
                Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
                Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
                Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
                Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
                Author notes
                Address correspondence to: Douglas P. Slakey, MD, MPH, Department of Surgery, Tulane University School of Medicine, 1430 Tulane Ave, SL-22, New Orleans, LA 70112-2699, USA. Telephone: (504) 988-2317, Fax: (504)988-1874 E-mail: dslakey@ 123456tulane.edu
                Article
                Publisher ID: 12-03-046
                DOI: 10.4293/108680812X13517013317716
                PMC ID: 3662744
                PubMed ID: 23743371
                SO-VID: 0f3a026a-df63-46b6-b544-1fb1450c6dc0
                Copyright © © 2013 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/us/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

                History
                Categories
                Subject: Scientific Papers

                ScienceOpen disciplines: Surgery
                Keywords: liver resection,laparoscopic,ligasure
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: liver resection, laparoscopic, ligasure

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