Extended laparoscopic liver resection: initial experience and review of the literature


Marcel Autran Machado, MD, FACS, Rodrigo C. Surjan, MD, Tiago Basseres, MD, Fabio F. Makdissi

Annals of Laparoscopic and Endoscopic Surgery. 2017, 2: 32-37. doi: 10.21037/ales.2017.02.19



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Background: Laparoscopic extended liver resections have been limited to very few centers with only few cases reported so far. The aim with this study was to perform a comprehensive analysis of our experience with extended laparoscopic liver surgery using a prospective database.

Methods: In this study, consecutive patients undergoing extended laparoscopic liver surgery by this team between 2007 and 2016 were studied. The primary endpoint was safety of the procedure. Secondary endpoints were conversion rates, operative times, blood loss, need for transfusions, and hospital length of stay.

Results: Between 2007 and 2016, 23 extended laparoscopic liver resections were performed at our institution. Of these, 12 (52%) were performed as a second stage in a staged liver resection and 11 (48%) were performed during one-stage resection with or without preoperative portal vein embolization. There were 13 women and 10 men with mean age of 56.3 years old [22–73]. The main indication for liver resection was colorectal liver metastases. Two patients required conversion to open surgery, one due to hemorrhage and one due to technical difficulties. Blood loss was significant in 6 patients with need for transfusion. The mean operative time was 245 minutes. Median hospital stay was 7 days. Significant complications occurred in six patients (26.1%). No 90-day mortality was observed.

Conclusions: This observational study shows that laparoscopic extended liver resections are safe and feasible. Adequate analysis of quality and volume of the future liver remnant (FLR) is essential. Complications, operative times, hospital stay and blood loss were comparable to open extended liver resections.