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- W2345227450 abstract "Aims: Recently laparoscopy has gained presence in several fields of general surgery as colorectal, bariatric and upper abdominal surgery. Conversely, this is not true for hepatobiliary surgery, related to fear of a massive bleeding. Our objective is to study indications, contraindications and feasibility of pure laparoscopic hepatectomies (LH). Methods: LH was considered in «ideal» cases with greater chance of success. Exclusion criteria for LH were previous open hepatectomy (OH), Child-Pugh B or C, clinically significant portal hypertension and morbidities contraindicating major surgery. As experience was achieved, more demanding resections were attempted, starting with lesions located in peripheral segments but deeper in the parenchyma and, subsequently, major hepatectomies and rehepatectomies. According to the procedure, 3 to 6 ports were inserted with a semicircular distribution. Laparoscopic ultrasound evaluation was routinely performed. Transection was performed combining CUSA and Harmonic. Specific complications of liver surgery were systematically collected, using IGSLS score. Results: Since 2010 we performed 112 LH in our department, by the same surgeon, including 24 major hepatectomies, 15 lesions in posterior segments, 2 resections in both hemilivers, 3 LH combined with primary resection, 11 redo surgery and a two stage hepatectomy. Conversion rate dropped to 6% and the ratio OH vs LH evolved from 8:1 to 1:1. Complications in LH were 3(2,7%) biliary fistulas, 6(5,5%) collections, 8(7,3%) hemorrhages and in 4(3,6%) patients liver insufficiency. Reoperation rate was 4,5%. Median hospital stay was 4 (1–60) days. Conclusions: Far from the consequences of learning curve in terms of morbidity and mortality, we experience a significant reduction of infective complications and hospital stay compared to open surgery. Currently half of liver resections are being done by laparoscopic surgery in our department, what is more than expected compared to the current experience published in multicentric reports." @default.
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- W2345227450 date "2016-04-01" @default.
- W2345227450 modified "2023-09-26" @default.
- W2345227450 title "Which is the limit for laparoscopic hepatectomies?" @default.
- W2345227450 doi "https://doi.org/10.1016/j.hpb.2016.01.417" @default.
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