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Journal of Gastroenterology and Digestive Diseases | Volume 3
May 25-26, 2018 | New York, USA
World Liver Conference 2018
L
aparoscopic liver resections (LLR) represent the new
frontier of liver surgery. During the last decade indications
for the laparoscopic approach to the liver have been widely
extended, from peripheral benign lesions to malignant
neoplasms, difficult localizations and major resections.
Laparoscopic liver surgery was slower to develop than
other fields of laparoscopic surgery because of a steep
learning curve, and fear of uncontrolled bleeding or gas
embolism. However, LLR is associated with significant
advantages of laparoscopic procedures. The aim of this
retrospective study is to evaluate the extent and safety of
the learning curve for LLR. We retrospectively analysed 87
patients who underwent a LLR from July 2010 to November
2017 performed by a single senior surgeon. At the start of
experience the indication was a single lesion, whereas in the
last years an increasing number of patients were enrolled
for laparoscopic intervention, according to the learning
curve. Diseases included liver cancer, hepatic hemangioma,
focal nodular hyperplasia, liver abscess, and metastatic liver
cancer. The diagnosis was a malignant neoplasm for 53
patients (61%), a benign lesion for the remaining cases. In
45 patients a synchronous procedure was performed (four
right colectomy, six left colectomy, eight rectal resection,
two gastric resection, 21 cholecystectomy and four for other
procedures). 35 patients were males and 42 were females,
with a mean age of 60 years (range 23-88). 81 patients (93%)
had a good preoperatory hepatic function, assessed with A
Child-Pugh score. We performed 63 wedge resections (72%),
two segmentectomies, four right lateral bisegmentectomies,
13 left lobectomies (15%), four left hepatectomies and
one robotic right hepatectomy; the latter converted for
intraoperatory bleeding. Median operative time was
120 minutes (35-330). There were no intraoperative or
postoperative deaths and 26% of morbidity (ascites in seven
patients, fever in seven patients, pneumonia in four patients,
one needed blood transfusion and three surgery-related
complications occurred). Only onemajor complication (grade
III of Clavien-Dindo classification) was observed, in a patient
who received a synchronous proctectomy and needed
reoperation for anastomotic dehiscence. The median time of
discharge was five days (range 2-11). A negative histological
margin (R0) was obtained in 88% of malignancy cases. In our
experience laparoscopic surgery is a safe option for hepatic
resection in benign such as malignant lesions, good patient
selection and refined surgical technique are the keys to
successful of LLR, especially at the beginning of the learning
curve as well as the experience of the surgeon in advanced
laparoscopic procedures and hepatobiliary surgery.
e:
fralattanzio@hotmail.comLaparoscopic liver resections: An innovative approach to the liver in a single centre experience
F Lattanzio
1, 2
, C Bizzoca
1, 3
and
L Vincenti
1
1
Chirurgia Generale Balestrazzi, Policlynic Hospital, Italy
2
Dimiccoli Hospital, Italy
3
De Bellis Hospital, Italy