Early experience with totally laparoscopic major hepatectomies: single institution experience with 31 consecutive cases

    loading  Checking for direct PDF access through Ovid


Laparoscopic surgery was first introduced in the late eighties and since then, it has been rapidly adopted in the field of abdominal surgery. Although laparoscopic surgery has become almost routine for simple abdominal surgeries such as cholecystectomies1 and appendicectomies,2 its use for more complex abdominal surgeries as hepatectomies has been more limited. The first laparoscopic hepatectomy (LH) was reported by Gagner et al. in 19923 and the first case series by Cherqui et al.4 However, the adoption of LH by liver surgeons has been relatively slow due to the technical complexity of liver surgery and many liver surgeons remain reluctant to pursue LH even today. The main challenges to LH are the risk of major haemorrhage that can be challenging to control laparoscopically and concerns about oncological margins.5 In Southeast Asia, only a handful of surgical series reporting on LH mainly consisting of minor hepatectomies have been reported.6
Over the past decade, there have been a rapid increase in the number of large single center series reporting excellent outcomes after LH.11 As increasing number of studies report that LH is associated with superior perioperative outcomes such as decreased blood loss and shorter length of stay without any compromise to oncological outcomes and patient safety compared to the open approach;9 more and more liver surgeons world‐wide have begun to embrace LH. In 2008, a consensus meeting of 45 experts in liver surgery concluded that LH was feasible and safe when performed by surgeons experienced in both laparoscopic and liver surgery12 especially for minor liver resections of tumors located in the accessible anterolateral segments (segments 2, 3, 4b, 5 and 6).
Laparoscopic major hepatectomy (LMH) was first reported by Huscher et al.15 Not unexpectedly, adoption of LMH has been even slower and more limited. The first case series was reported by O'Rourke et al. from Australia in 200316 and subsequently there has been increased interest in this technique mainly from major high‐volume liver centers world‐wide.17 In 2009, a multicenter study reported that LMH could be performed safely in expert centers.17 In a more recent systematic review of all LH performed world‐wide, 9527 LH were reported from 179 single center series.5 Of these, there were 2590 (27%) LMH.
Nonetheless even today, LMH remains a relatively rare procedure with most experiences reported only from high‐volume expert centers.17 Reports of the totally laparoscopic approach are even more limited as many centers have advocated the use of hand‐assistance or the hybrid technique (laparoscopic assistance) especially during their early experience. In the present study, we report our initial experience with our first 31 consecutive major hepatectomies performed via the totally laparoscopic approach to determine its safety and feasibility.

Related Topics

    loading  Loading Related Articles