HP02 LESSONS LEARNT FROM 170 LAPAROSCOPIC LIVER RESECTIONS

Introduction:   Laparoscopic liver surgery is being practiced more widely. We would like to report an experience of 170 laparoscopic liver resections. Methods:   Data was collected in a prospective fashion from five surgeons, beginning in 1997 with left lateral sectionectomy, and right hepatectomy in 1999. Parenchymal transection was effected with linear cutting staplers, harmonic shears, and most recently, the Ligasure bipolar device. Results:   We attempted 27 major resections, 63 sectionectomies, and 80 minor resections. Only rarely were procedures hand-assisted, or “hybrid”. The conversion rate was 8%. Median blood loss was 250 ml. (Range 0–41) Median operative time was 120 minutes. Fifty-one percent of resections were for malignancy. Margins were positive in 5 patients. The overall post operative morbidity was 12%. There were 4 bile leaks. There was one death. Discussion:   The indications for surgery should be the same as for open liver resection, however tempting it may be to offer definitive diagnosis by removing peripheral, probably benign, lesions. Approximately 20% of our liver resections are attempted laparoscopically. Most left lateral sectionectomies are performed this way. Major hepatectomies should be attempted only if the tumour is well clear of the plane of transection. Non-anatomic resections require intraoperative ultrasound to ensure adequate margins and to identify large vessels. The ability to suture laparoscopically is essential. Conclusion:   The evolving technology of parenchymal transection devices makes laparoscopic liver surgery an exciting frontier. Surgeons must be skilled in open liver surgery and advanced laparoscopy before attempting more than the simplest of procedures.