Laparoscopic liver resections: A feasibility study in 30 patients

Objective To assess the feasibility and safety of laparoscopic liver resections. Summary Background Data The use of the laparoscopic approach for liver resections has remained limi ted for technical reasons. Progress in laparoscopic procedures and the deve lopment of dedicated technology have made it possible to consider laparosco pic resection in selected patients. Methods A prospective study of laparoscopic liver resections was undertaken in pati ents with preoperative diagnoses including benign lesion; hepatocellular ca rcinoma with compensated cirrhosis, and metastasis of noncolorectal origin. Hepatic involvement had to be limited and located in the left or periphera l right segments (segments 2-6), and the tumor had to be 5 cm or smaller. S urgical technique included CO2 pneumoperitoneum and liver transection with a harmonic scalpel, with or without portal triad clamping or hepatic vein c ontrol. Portal pedicles and large hepatic veins were stapled. Resected spec imens were placed in a bag and removed through a separate incision, without fragmentation. Results From May 1996 to December 1999, 30 of 159 (19%) liver resections were inclu ded. There were 18 benign lesions and 12 malignant tumors, including 8 hepa tocellular carcinomas in cirrhotic patients. Mean tumor size was 4.25 cm. T here were two conversions to laparotomy (6.6%). The resections included 1 l eft hepatectomy, 8 bisegmentectomies (2 and 3), 9 segmentectomies, and 11 a typical 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. Conclusion Laparoscopic resections are feasible and safe in selected patients with lef t-sided and right-peripheral lesions requiring limited resection. Young pat ients with benign disease clearly benefit from avoiding a major abdominal i ncision, and cirrhotic patients may have a reduced complication rate.