Laparoscopic liver resection: Where do we stand today?
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318 Hellenic Journal of Surgery 2010; 82: 5
Laparoscopic Liver Resection: Where Do We Stand Today? Review Article S. Lanitis, Ch. Kontovounisios, M. Korontzi, V. Zafeiriadou, Ch. Karaliotas, G. Sgourakis, C. Karaliotas Received 18/05/2010 Accepted 23/07/2010
Abstract Aim-Background: Liver resection is one of the last fortresses to resist the invasion of laparoscopic surgery. Limitations to a wider application of the procedure include the significant learning curve, the demand for sophisticated equipment and some technical issues related to the inability to laparoscopically reproduce manipulations of the open approach. The main goal of this review is to present the global experience to date concerning laparoscopic liver resection (LLR) and provide answers to the main questions surrounding this technique. Methods: A literature search for cited English publications was performed via Pubmed using laparoscopic liver or hepatic resection as key words. All titles and abstracts were screened and those related to the theme of this review article were selected. Results: The main questions addressed and answered considering LLR were: What are the indications and contraindications for LLR, which LLRs are technically feasible, how safe and effective is the LLR procedure and is LLR an oncologically safe technique? Conclusions: The indications and contraindications remain the same as those for the open approach but the feasibility depends on technical issues. Totally LLR appears safe for lesions located in the anterior and lateral segments but is also viable for central and posterior segments. With careful patient selection, experience and good equipment, good results can be expected from LLR in terms of morbidity and mortality as well as in oncological safety. More studies are necessary in order to prove that this approach should eventually replace part of the open liver surgery.
Keywords
Laparoscopic liver resection, Laparoscopic hepatectomy, Minimally invasive liver surgery
2nd Surgical department and Surgical Oncology Unit “Korgialenio Benakio”, Red Cross Hospital, Athens, Greece Email: [email protected]
Introduction Over the last two decades, laparoscopic surgery has dramatically pervaded almost all fields of surgery and has evolved to become the approach of choice for many procedures. Since the first reported LLR, almost 20 years ago, less than 3500 procedures have been performed globally [1-4]. Even today, only few centres apply LLR systematically and the reasons for its restrained popularity and spread of the technique involve mainly technical issues derived from the difficulty in laparoscopically reproducing the basic surgical manipulations used in the traditional approach. These manipulations include direct control of the portal triad, palpation mobilization and dissection of the parenchyma. Moreover, there has been an increased concern for intractable intraoperative haemorrhage and gas embolism and, as with any new technique, questions have been raised concerning the oncological safety of LLR. Consequently, des
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