Hand-assisted laparoscopic liver resection - Lessons from initial experience

Background: Recent innovations in laparoscopic instrumentation make routine resection of solid organs a clinical possibility. Hypothesis: Hand-assisted laparoscopic liver resection is a safe and feasib le procedure for solitary cancers requiring removal of 2 segments of liver or less. Design and Patients: Eleven patients with liver tumors deemed technically r esectable by laparoscopic techniques were subjected to laparoscopic evaluat ion and attempted hand-assisted laparoscopic resection between July 1998 an d July 1999. During the same period, 230 patients underwent open liver rese ction. Setting: Tertiary care referral center for liver cancer. Main Outcome Measures: Success of laparoscopic resection, reasons for conve rsion to open liver resection, blood loss, tumor clearance margin, complica tions, and length of hospital stay. Results: Five patients underwent successful resection by the hand-assisted laparoscopic technique. Data from the 5 successful cases and the 6 aborted casts are presented to outline the issues and the lessons learned. Conclusions: In selected patients, hand-assisted laparoscopic liver resecti on can be safely performed and might have potential advantages over traditi onal liver resection if the tumor is limited to the left lateral segment or is at the margins of the liver.