Laparoscopic management of benign solid and cystic lesions of the liver

Objective The authors present their experience in the laparoscopic manageme nt of benign liver disease. The aim of the study is to analyze technical fe asibility and evaluate immediate and long-term outcome. Summary Background Data Indications for the laparoscopic management of vari ed abdominal conditions have evolved. Although the minimally invasive treat ment of liver cysts has been reported, the laparoscopic approach to other l iver lesions remains undefined. Methods Between September 1990 and October 1997, 43 patients undenrwent lap aroscopic liver surgery. There were two groups of benign lesions: cysts (n = 31) and solid tumors (n = 12). indications were solitary giant liver cyst s (n = 16), polycystic liver disease (n = 9), hydatid cyst (n = 6), focal n odular hyperplasia (n = 3), and adenoma (n = 9). Only solid tumors, hydatid cysts, and patients with polycystic disease and large dominant cysts locat ed in anterior liver segments were included. All giant solitary liver cysts were considered for laparoscopy. Patients with cholangitis, cirrhosis, and significant cardiac disease were excluded. Data were collected prospective ly. Results The procedures were completed laparoscopically in 40 patients. Medi an size was 4 cm for solid nodules and 14 cm for solitary liver cysts. Conv ersion occurred in three patients (7%), for bleeding (n = 2) and impingemen t of a solid tumor on the inferior vena cava (n = 1). The median operative time was 179 minutes. All solitary liver cysts were fenestrated in less tha n 1 hour. There were no deaths. Complications occurred in 6 cases (14.1%). Two hemorrhagic and two infectious complications were noted after managemen t of hydatid cysts. There were no complications after resection of solid tu mors. Three patients received transfusions (7%). The median length of stay was 4.7 days. Median follow-up was 30 months. There was no recurrence of so litary liver or hydatid cysts. One patient with polycystic disease had symp tomatic recurrent cysts at 6 months requiring laparotomy. Conclusion Laparoscopic liver surgery can be accomplished safely in selecte d patients with small benign solid tumors located in the anterior liver seg ments and giant solitary cysts. The laparoscopic management of polycystic l iver disease should be reserved for patients with a limited number of large , anteriorly located cysts. Hydatid disease is best treated through an open approach.