Laparoscopic Left Lateral Liver Sectionectomy: A Safe, Efficient, Reproducible Technique

Hilal, Mohammed Abu; Pearce, Neil

doi:10.1159/000155222

Cited by 65 publications

(49 citation statements)

References 27 publications

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“…Virtually all left sections (removal of segments 2 and 3) are performed laparoscopically (Abu Hilal and Pearce, 2008). These results are consistent with experience in other centres (Nguyen et al, 2009).…”

Section: Minimally Invasive Surgerysupporting

confidence: 86%

Surgery for colorectal liver metastases

Primrose

2010

Br J Cancer

110

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In this review the surgery of colorectal liver metastases is discussed. It has long been known that liver surgery can cure metastatic colorectal cancer although in only a small proportion of the population with the disease. However with better understanding of the natural history of the condition and advances in technique more patients can have safe, potentially curative surgery. The multidiscipline management of patients with effective chemotherapy has led to more patients benefiting from surgery after reducing the size of the metastases and allowing operation on patients who were previously inoperable. Chemotherapy also improves at least the medium-term outcome in those who are operable at the outset. Minimally invasive techniques have been developed so that major hepatectomy may be accomplished in up to half of such cases with a very short hospital stay and limited interference with quality of life. Lastly, using portal vein embolisation to cause hypertrophy of the future liver remnant and on occasions combining it with staged liver resection allows potentially curative surgery on patients who previously could not have survived resection. These developments have led to more patients being cured of advanced colorectal cancer.

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Section: Minimally Invasive Surgerysupporting

confidence: 86%

Surgery for colorectal liver metastases

Primrose

2010

Br J Cancer

110

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“…From a previous series of 174 patients undergoing LLR, it has been demonstrated that increasing experience is associated with a reduction in operating time, conversion rate, blood loss and operative morbidity whilst at the same time performing more complex resections and more resections for malignant disease. Some authors suggest that a learning curve of approximately 60 cases is required to become fully familiar with the techniques of LLR [30] as suggested by others [26,31]. However, more latterly some of the cases reported in the current series have been done by senior HPB surgical trainees under consultant supervision making the learning curve within this series more difficult to evaluate.…”

Section: Discussionmentioning

confidence: 92%

Laparoscopic Liver Resection: Is There a Learning Curve?

et al. 2012

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Background: Laparoscopic liver resection (LLR) is becoming an accepted treatment option for resecting both benign and malignant tumours. However, it is critical that the laparoscopic approach does not compromise the technical quality of the liver resection. The aim of this paper was to review the learning curve of LLR in a specialist HPB unit. Methods: A prospective database was searched to identify patients undergoing LLR over a 4-year period. To assess the effect of the learning curve on outcome, the series was evaluated during two eras – early versus late. Results: Fifty-one (27 males, median age 68 years) patients were identified with 37 having LLR. The most common indication was for colorectal liver metastases, and the most common procedure was a non-anatomical metastectomy. Changes in management decisions (n = 14) occurred more frequently during the first era (9 vs. 5; p > 0.05). More patients underwent right hepatectomy in the late group (3 vs. 1; p < 0.05). There did not appear to be any difference in duration of surgery for laparoscopic left lateral resection between the eras (200 vs. 240 min; p > 0.05) which probably reflected trainees performing more operations during the late era. Left hepatectomy was most commonly performed in the early era compared to more right hepatectomies during the late era. Conclusion: LLR is associated with a learning curve, but once this has been overcome it can be safely utilised in the management of malignant liver lesions even for major resections, surgical training and simultaneous resections.

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“…No hand-assisted or ‘hybrid’ techniques [26] were used. Our group have previously described the technique for left lateral sectionectomy, major hemi-hepatectomy and segmentectomies [8,11,24]. …”

Section: Methodsmentioning

confidence: 99%

“…In expert hands, the feasibility, safety and efficiency of the laparoscopic approach have been demonstrated when appropriate criteria are applied to patient selection [2,3,4,5,6,7,8,9,10,11]. In a recent review including approximately 2,800 patients, the mortality and morbidity rates were reported to be 0.3 and 10.5%, respectively [1].…”

Section: Introductionmentioning

confidence: 99%

Surgical Management of Benign and Indeterminate Hepatic Lesions in the Era of Laparoscopic Liver Surgery

Hilal¹,

Fabio²,

Teng³

et al. 2011

Dig Surg

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Background/Aims: The expansion of the laparoscopic approach for the management of benign liver lesions has raised concerns regarding the risk of widening surgical indications and compromising safety. Large single-centre series focusing on laparoscopic management of benign liver lesions are sporadic. Methods: We reviewed a prospectively collected database of patients undergoing pure laparoscopic liver resection (LLR) for benign liver lesions. All cases were individually discussed at a multidisciplinary team meeting. Results: Forty-six patients underwent 50 LLRs for benign disease. Indications for surgery were: symptomatic lesions, preoperative diagnosis of adenoma or cystadenoma, and lesions with an indeterminate diagnosis. The preoperative diagnosis was uncertain in 11 cases. Of these, histological diagnosis was hepatocellular carcinoma in one (9%) and benign lesion in 10 patients (91%). Thirteen patients (28%) required major hepatectomy. Three patients (7%) developed postoperative complications. Mortality was nil. The median postoperative hospital stay following major and minor hepatectomy was 4 and 3 days, respectively. Conclusion: The laparoscopic approach represents a safe option for the management of benign and indeterminate liver lesions, even when major hepatectomy is required. LLR should be only performed in specialized centres to ensure safety and strict adherence to orthodox surgical indication.

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Laparoscopic Left Lateral Liver Sectionectomy: A Safe, Efficient, Reproducible Technique

Cited by 65 publications

References 27 publications

Surgery for colorectal liver metastases

Surgery for colorectal liver metastases

Laparoscopic Liver Resection: Is There a Learning Curve?

Surgical Management of Benign and Indeterminate Hepatic Lesions in the Era of Laparoscopic Liver Surgery

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