Original Article

J Minim Invasive Surg 2012; 15(4): 93-99

Published online December 15, 2012

https://doi.org/10.7602/jmis.2012.15.4.93

© The Korean Society of Endo-Laparoscopic & Robotic Surgery

복강경 간절제술의 초기 경험을 통하여 얻은 교훈

김자연1,2ㆍ안영준1ㆍ이해원1ㆍ정인목1ㆍ정중기1ㆍ허승철1ㆍ황기태1ㆍ안혜성1

서울특별시 보라매병원1, 서울대학교 의과대학 외과학교실2

Lessons from the Initial Experience of Laparoscopic Liver Resection

Ja Yeon Kim, M.D.1,2, Young Joon Ahn, M.D.1, Hae Won Lee, M.D.1, In Mok Jung, M.D.1, Jung Kee Chung, M.D.1, Seung Chul Heo, M.D.1, Ki-Tae Hwang, M.D.1, Hye Seong Ahn, M.D.1

1Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 2Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Purpose: This study was conducted to evaluate the initial experience of 24 cases of laparoscopic liver resection by a single surgeon to determine its feasibility and report perioperative complications associated with this technique.
Methods: A retrospective analysis of data from 24 patients who received attempted laparoscopic liver resections for primary liver tumors from November 2008 to April 2012 was conducted. Sixteen benign and eight primary malignant lesions were included. The patient's electronic medical records including age, gender, underlying disease, past medical history, type of operations, operative time, complications, conversion rates, and length of hospital stay were reviewed.
Results: The mean age of the patients was 52.6 years and the mean operation time was 263.7 minutes. The overall morbidity was 12.5% and the mortality was zero. One case was converted to open surgery (4.2%), while intraoperative transfusion was conducted in four cases. The types of operations included left hepatectomy (n=12, 50%; 3 with CBD exploration), left lateral sectionecectomy (n=4, 16.7%; 1 with cholecystectomy), partial hepatectomy for benign tumor (n=3, 12.5%: 1 with cholecystectomy), right hepatectomy (n=1, 4.1%), S6 segmentectomy (n=1, 4.1%), and tumorectomy (n=3, 12.5%). The mean estimated blood loss during operation was 375.3 cc and the postoperative hospital stay was 7.7 days. Additionally, one intraoperative complication and two postoperative complications occurred (12.5%). There was no postoperative mortality.
Conclusion: The results of this study indicate that laparoscopic surgery with HBP training is suitable for laparoscopic liver resection. However, to ensure safety of the liver resection and the advantages of laparoscopic surgery, a thorough understanding of hepatic anatomy and elaborate surgical planning is essential.

Keywords Laparoscopy, Hepatectomy, Complication

  1. Gagner M, Rheault M, Dubuc J. Laparoscopic partial hepatectomy for liver tumor. Surg Endosc 1992;6:99.
  2. Ferzli G, David A, Kiel T. Laparoscopic resection of a large hepatic tumor. Surg Endosc 1995;9:733-735.
    Pubmed CrossRef
  3. Azagra JS, Gowergen M, Gilbart E, Jacobs D. Laparoscopic anatomical left latera l segmentectomy? technical aspects. Surg Endosc 1996;10:758-761.
    Pubmed CrossRef
  4. Hong G, Han HS, Yoon YS, Cho JY, Ahn KS. Outcome of laparoscopic liver resection for hepatocellular carcinoma. Korean J Hepatobiliary Pancreat Surg 2009;13:221-226.
  5. Cherqui D, Husson E, Hammoud R, et al. Laparoscopic liver resections: a feasibility st udy in 30 patients. Ann Surg 2000;232:753-762.
    Pubmed KoreaMed CrossRef
  6. Dulucq JL, Wintringer P, Sta bilini C, Berticelli J, Mahajna A . Laparoscopic liver resections: a single-center experience. Surg Endosc 2005;19:886-891.
    Pubmed CrossRef
  7. Laurent A, Cherqui D, Lesurtel M, Brunetti F, Tayar C, Fagniez PL. Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg 2003;138:763-769.
    Pubmed CrossRef
  8. Kaneko H, Takagi S, Otsuka Y, et al. Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg 2005;189:190-194.
    Pubmed CrossRef
  9. Han HS, Cho JY, Yoon YS. Techniques for performing laparoscopic liver res ection in various hepatic locations. J Hepatobiliary Pancreat Surg 2009;16:427-432. 10.Song YJ, Kim KJ, Moon HG, et al. The feasibility of laparoscopic hepatectomy for the patients with left intrahepati c stones. J Korean Surg Soc 2010;78:35-40.
    CrossRef
  10. Gayet B, Cavaliere D, Vibert E, et al. Totally laparoscopic right hepatectomy. Am J Surg 2007;194:685-689.
    Pubmed CrossRef
  11. Gumbs AA, Gayet B. Totally laparoscopic left hepatectomy. Surg Endosc 2007;21:1221.
    Pubmed CrossRef
  12. Gumbs AA, Gayet B. Totally laparoscopic central hepatectomy. J Gastrointest Surg 2008;12:1153. 14.Gumbs AA, Gayet B. Multimedi a article: totally laparoscopicextended right hepatect omy. Surg Endosc 2008;22:2076-2077.
    Pubmed CrossRef
  13. Gumbs AA, Bar-Zakai B, Gayet B. Totally laparoscopic extended left hepatectomy. J Gastrointest Surg 2008;12:1152.
    Pubmed CrossRef
  14. Huang MT, Lee WJ, Wang W, Wei PL, Chen RJ. Hand assisted laparoscopic hepatectomy for solid tumor in the posterior portion of the right lobe: initial experience. Ann Su rg 2003;238:674-679.
    Pubmed KoreaMed CrossRef
  15. Gumbs AA, Gayet B. V ideo: the lateral la paroscopicapproach to lesions in the posterior segments. J Gastrointest Surg 2008;12:1154.
    Pubmed CrossRef
  16. Kaneko H, Otsuka Y, Tsuchiya M, Tamura A, Katagiri T, amazaki K. Application of devices for safe laparoscopic hepatectomy. HPB (Oxford) 2008;10:219-224.
    Pubmed KoreaMed CrossRef
  17. Jain G, Parmar J, Mohammed MM, et al. Stretching the limits of laparoscopic surgery: two-stage laparoscopic liver resection . J Laparoendosc Adv Surg Tech A 2010;20:51-54.
    Pubmed CrossRef
  18. Yu H, Wu SD, Chen DX, Zhu G. Laparoscopic resection of Bismuth type I and II hilar cholangiocarcinoma: an audit of 14 cases from two institutions. Dig Surg 2011;28:44-49.
    Pubmed CrossRef
  19. Otsuka Y, Katagiri T, Ishii J, et al. Gas embolism in laparoscopic hepatectomy: what is the optimal pneumoperitoneal pressure for laparoscopic major hepatectomy? J Hepatobiliary Pancreat Sci 2012 [Epub ahead of print].
  20. Buell JF, Cherqui D, Geller DA, et al. The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann Surg 2009;250:825-830.
    Pubmed CrossRef
  21. Lee MG, Lee HJ, Kim MH, et al. Extrahepatic biliary diseases: 3D MR cholangiopancreatography compared with endoscopic retrograde cholangiopancreatography. Radiology 1997;202:663-669.
    Pubmed CrossRef
  22. Kim MJ, Mitchell DG, Ito K, Outwater EK. Biliary dilatation:differentiation of benign from m alignant causes-value of adding conventional MR imaging to M R cholangiopancreatography. Radiology 2000;214:173-181.
    Pubmed CrossRef
  23. Mazoch MJ, Dabbous H, Shokouh-Amiri H, Zibari GB. Management of giant liver cysts. J Surg Res 2011;167:e125-30.
    Pubmed CrossRef
  24. Lanthaler M, Freund M, Nehoda H. Laparoscopic resection of a giant liver hemangioma. J Laparoendosc Adv Surg Tech A 2005;15:624-626. 27.Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection-2,804 patients. Ann Surg 2009;250:831-841.
    Pubmed CrossRef
  25. Yamanaka J, Okada T, Saito S, et al. Minimally invasive laparoscopic liver resection: 3D MDCT simulation for preoperative planning. J Hepatobiliary Pancreat Surg 2009;16:808-815.
    Pubmed CrossRef
  26. Sugita M, Nagahori K, Kudo T, et al. Diaphragmatic hernia resulting from injury during microwave-assisted laparoscopic hepatectomy. Surg Endosc 2003;17:1849-1850,
    Pubmed CrossRef

Article

Original Article

J Minim Invasive Surg 2012; 15(4): 93-99

Published online December 15, 2012 https://doi.org/10.7602/jmis.2012.15.4.93

Copyright © The Korean Society of Endo-Laparoscopic & Robotic Surgery.

복강경 간절제술의 초기 경험을 통하여 얻은 교훈

김자연1,2ㆍ안영준1ㆍ이해원1ㆍ정인목1ㆍ정중기1ㆍ허승철1ㆍ황기태1ㆍ안혜성1

서울특별시 보라매병원1, 서울대학교 의과대학 외과학교실2

Lessons from the Initial Experience of Laparoscopic Liver Resection

Ja Yeon Kim, M.D.1,2, Young Joon Ahn, M.D.1, Hae Won Lee, M.D.1, In Mok Jung, M.D.1, Jung Kee Chung, M.D.1, Seung Chul Heo, M.D.1, Ki-Tae Hwang, M.D.1, Hye Seong Ahn, M.D.1

1Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 2Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose: This study was conducted to evaluate the initial experience of 24 cases of laparoscopic liver resection by a single surgeon to determine its feasibility and report perioperative complications associated with this technique.
Methods: A retrospective analysis of data from 24 patients who received attempted laparoscopic liver resections for primary liver tumors from November 2008 to April 2012 was conducted. Sixteen benign and eight primary malignant lesions were included. The patient's electronic medical records including age, gender, underlying disease, past medical history, type of operations, operative time, complications, conversion rates, and length of hospital stay were reviewed.
Results: The mean age of the patients was 52.6 years and the mean operation time was 263.7 minutes. The overall morbidity was 12.5% and the mortality was zero. One case was converted to open surgery (4.2%), while intraoperative transfusion was conducted in four cases. The types of operations included left hepatectomy (n=12, 50%; 3 with CBD exploration), left lateral sectionecectomy (n=4, 16.7%; 1 with cholecystectomy), partial hepatectomy for benign tumor (n=3, 12.5%: 1 with cholecystectomy), right hepatectomy (n=1, 4.1%), S6 segmentectomy (n=1, 4.1%), and tumorectomy (n=3, 12.5%). The mean estimated blood loss during operation was 375.3 cc and the postoperative hospital stay was 7.7 days. Additionally, one intraoperative complication and two postoperative complications occurred (12.5%). There was no postoperative mortality.
Conclusion: The results of this study indicate that laparoscopic surgery with HBP training is suitable for laparoscopic liver resection. However, to ensure safety of the liver resection and the advantages of laparoscopic surgery, a thorough understanding of hepatic anatomy and elaborate surgical planning is essential.

Keywords: Laparoscopy, Hepatectomy, Complication

References

  1. Gagner M, Rheault M, Dubuc J. Laparoscopic partial hepatectomy for liver tumor. Surg Endosc 1992;6:99.
  2. Ferzli G, David A, Kiel T. Laparoscopic resection of a large hepatic tumor. Surg Endosc 1995;9:733-735.
    Pubmed CrossRef
  3. Azagra JS, Gowergen M, Gilbart E, Jacobs D. Laparoscopic anatomical left latera l segmentectomy? technical aspects. Surg Endosc 1996;10:758-761.
    Pubmed CrossRef
  4. Hong G, Han HS, Yoon YS, Cho JY, Ahn KS. Outcome of laparoscopic liver resection for hepatocellular carcinoma. Korean J Hepatobiliary Pancreat Surg 2009;13:221-226.
  5. Cherqui D, Husson E, Hammoud R, et al. Laparoscopic liver resections: a feasibility st udy in 30 patients. Ann Surg 2000;232:753-762.
    Pubmed KoreaMed CrossRef
  6. Dulucq JL, Wintringer P, Sta bilini C, Berticelli J, Mahajna A . Laparoscopic liver resections: a single-center experience. Surg Endosc 2005;19:886-891.
    Pubmed CrossRef
  7. Laurent A, Cherqui D, Lesurtel M, Brunetti F, Tayar C, Fagniez PL. Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg 2003;138:763-769.
    Pubmed CrossRef
  8. Kaneko H, Takagi S, Otsuka Y, et al. Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg 2005;189:190-194.
    Pubmed CrossRef
  9. Han HS, Cho JY, Yoon YS. Techniques for performing laparoscopic liver res ection in various hepatic locations. J Hepatobiliary Pancreat Surg 2009;16:427-432. 10.Song YJ, Kim KJ, Moon HG, et al. The feasibility of laparoscopic hepatectomy for the patients with left intrahepati c stones. J Korean Surg Soc 2010;78:35-40.
    CrossRef
  10. Gayet B, Cavaliere D, Vibert E, et al. Totally laparoscopic right hepatectomy. Am J Surg 2007;194:685-689.
    Pubmed CrossRef
  11. Gumbs AA, Gayet B. Totally laparoscopic left hepatectomy. Surg Endosc 2007;21:1221.
    Pubmed CrossRef
  12. Gumbs AA, Gayet B. Totally laparoscopic central hepatectomy. J Gastrointest Surg 2008;12:1153. 14.Gumbs AA, Gayet B. Multimedi a article: totally laparoscopicextended right hepatect omy. Surg Endosc 2008;22:2076-2077.
    Pubmed CrossRef
  13. Gumbs AA, Bar-Zakai B, Gayet B. Totally laparoscopic extended left hepatectomy. J Gastrointest Surg 2008;12:1152.
    Pubmed CrossRef
  14. Huang MT, Lee WJ, Wang W, Wei PL, Chen RJ. Hand assisted laparoscopic hepatectomy for solid tumor in the posterior portion of the right lobe: initial experience. Ann Su rg 2003;238:674-679.
    Pubmed KoreaMed CrossRef
  15. Gumbs AA, Gayet B. V ideo: the lateral la paroscopicapproach to lesions in the posterior segments. J Gastrointest Surg 2008;12:1154.
    Pubmed CrossRef
  16. Kaneko H, Otsuka Y, Tsuchiya M, Tamura A, Katagiri T, amazaki K. Application of devices for safe laparoscopic hepatectomy. HPB (Oxford) 2008;10:219-224.
    Pubmed KoreaMed CrossRef
  17. Jain G, Parmar J, Mohammed MM, et al. Stretching the limits of laparoscopic surgery: two-stage laparoscopic liver resection . J Laparoendosc Adv Surg Tech A 2010;20:51-54.
    Pubmed CrossRef
  18. Yu H, Wu SD, Chen DX, Zhu G. Laparoscopic resection of Bismuth type I and II hilar cholangiocarcinoma: an audit of 14 cases from two institutions. Dig Surg 2011;28:44-49.
    Pubmed CrossRef
  19. Otsuka Y, Katagiri T, Ishii J, et al. Gas embolism in laparoscopic hepatectomy: what is the optimal pneumoperitoneal pressure for laparoscopic major hepatectomy? J Hepatobiliary Pancreat Sci 2012 [Epub ahead of print].
  20. Buell JF, Cherqui D, Geller DA, et al. The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann Surg 2009;250:825-830.
    Pubmed CrossRef
  21. Lee MG, Lee HJ, Kim MH, et al. Extrahepatic biliary diseases: 3D MR cholangiopancreatography compared with endoscopic retrograde cholangiopancreatography. Radiology 1997;202:663-669.
    Pubmed CrossRef
  22. Kim MJ, Mitchell DG, Ito K, Outwater EK. Biliary dilatation:differentiation of benign from m alignant causes-value of adding conventional MR imaging to M R cholangiopancreatography. Radiology 2000;214:173-181.
    Pubmed CrossRef
  23. Mazoch MJ, Dabbous H, Shokouh-Amiri H, Zibari GB. Management of giant liver cysts. J Surg Res 2011;167:e125-30.
    Pubmed CrossRef
  24. Lanthaler M, Freund M, Nehoda H. Laparoscopic resection of a giant liver hemangioma. J Laparoendosc Adv Surg Tech A 2005;15:624-626. 27.Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection-2,804 patients. Ann Surg 2009;250:831-841.
    Pubmed CrossRef
  25. Yamanaka J, Okada T, Saito S, et al. Minimally invasive laparoscopic liver resection: 3D MDCT simulation for preoperative planning. J Hepatobiliary Pancreat Surg 2009;16:808-815.
    Pubmed CrossRef
  26. Sugita M, Nagahori K, Kudo T, et al. Diaphragmatic hernia resulting from injury during microwave-assisted laparoscopic hepatectomy. Surg Endosc 2003;17:1849-1850,
    Pubmed CrossRef

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