Early results of totally laparoscopic liver resections: analysis of first 42 cases

Abstract

Objectives: Laparoscopic approach for liver surgery has become popular for some groups of patient because of its priority in terms of morbidity and oncological safety. Despite lots of advantages it remains technically demanded and require a long learning curve. Our centre has started laparoscopic liver surgery program in 2016. Present study is aimed to evaluate early results of this program.

Materials and methods: From December 2016 to October 2018 42 patients with malignant and benign lesions where planned for elective laparoscopic liver resection. The indication were as follows: giant symptomous hemangioma in 10 patients (23.8%); liver adenoma in 12 patients (28.5%), cystadenoma in 3 patients (4.7%); hydatid cyst, resistant to conservative treatment in 7 patients (16.7%); small hepatocellular carcinoma in 7 patients (16.7%); colorectal liver metastasis in 1 patient (2.3%) and other liver metastasis in 2 patients (4.7%). Intention malignant to benign in this series was 10/32. Median of lesion size was 63.2 mm (from 10 to 110 mm). Four patients had previous open abdominal surgery – two had colon resections, one had urgent laparotomy in local hospital due to bleeding from tumor rapture and one patient had trisectionectomy due to huge fibrolamellar HCC and was operated laparoscopically due to tumor recurrence in remnant liver.

Results: The procedures included 9 (22.5%) major hepatectomies, including 8 left lobectomies and 1 right posterior sectionectomy, and 33 (77.4%) minor resections. By IWATE classification of difficulty there were 3 (7.1%) low-complexity, 21 (50%) intermediate-complexity and 18 (42.8%) high-complexity procedures. IWATE complexity score ranged from 2 to 8 points. There was one conversion to hybrid procedure due to absence of progression in liver transection (conversion rate 2,3%). Mean blood loss was 326 ml (range 0–1500 ml). Mean operative time was 265 min (range 167–400 min). No major complications were observed. Among minor complication were observed wound infection in 4 patients and abdominal liquor collection, treated conservatively in 3 patients. Overall morbidity was 16.7%. There were no deaths and no reoperations. Mean of hospital stay was 7.8 days (range 5 – 11 days).

Conclusion: Laparoscopic approach is accessible option for advanced HPB centres, experienced in liver surgery, which shows good early results. Small liver lesion in anterior segments is optimal for beginning of laparoscopic liver surgery program. Laparoscopic hepatectomies became feasible with growing experience.