HP24P LAPAROSCOPIC LEFT LATERAL SECTIONECTOMY – CONTROLLING INDICATIONS AND AVOIDING PITFALLS

Introduction:   Laparoscopic left lateral sectionectomy has been described as the gold standard and is the most frequently performed laparoscopic liver resection, particularly early in ones experience. This operation can be very simple and quick but there remains the potential for significant morbidity and even mortality. The laparoscopic approach should not significantly broaden the indications for surgery. Methods:   This paper reports a consecutive series of 60 laparoscopic left lateral sectionectomies. We describe our technique which avoids any formal dissection of inflow or outflow. The mobilized left lateral section is separated from the liver using multiple firings of a linear cutting stapler device, in one, two, or occasionally three layers for bulky livers. Results:   The median procedure time was 90 min (30–310 min). Median blood loss was 200 ml (0–1400 ml), with six patients requiring laparoscopic suturing. There were 3 conversions, with one for bleeding. Sixty percent of lesions were benign, reflecting early enthusiasm and referral bias. However in the last two years all lesions removed have been malignant. Median length of hospital stay was 4 days (1–19). Our overall morbidity was 15%. There was one post operative death. Conclusion:   This approach offers all the benefits of laparoscopic surgery. Despite these good results we have still had significant problems and recommend strongly that it should only be performed by experienced liver surgeons, also skilled in laparoscopic surgery. The ability to suture laparoscopically is essential, and one must not view conversion as a technical failure. The indications for surgery should not be broadened.