RCT of open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery after surgery programme (ORANGE II study).

Abstract

IV-PCA was superior. Total opioid reduction and removal of the infusion pumps were achieved earlier in the IV-PCA group while opioid side-effects were more frequent in the EA group. Hospital stay was shorter in the IV-PCA group (median 74 vs 104h,p<0.001) Conclusion: Overall,IV-PCA demonstrated effective postoperative analgesia non-inferior to EA with a trend towards less side-effects and significantly shorter hospital length of stay.

Laparoscopic Resection for Liver Malignancies: Do the Elderly Benefit More?

“…A randomized trial of open and laparoscopic resection of primary HCC would be of great interest, as the published and ongoing randomized trials either involve only colorectal liver metastases 6 or several types of liver tumors. 7 The reduced complication rates reported in the current study are in line with previous studies, including a recently published randomized, controlled trial 6 Despite of this, the very low blood loss and complication rate in the laparoscopic group could also suggest a possible bias towards easier cases in the laparoscopic group. Also, the inverse T-incision reported for open resections is larger than many other centers would use.…”

Stepwise introduction of laparoscopic liver surgery: validation of guideline recommendations

“…These promising results have promptly increased the interest in LLS worldwide 1,2 and the first randomized controlled trials of laparoscopic vs. open liver surgery have been performed. 13,14 Despite these promising results, LLS remains challenging and should not be started without appropriate training and acquired surgical skills. During the 2015 Morioka consensus meeting 15 and more recently during the 2017 European guideline meeting on LLS in Southampton (EGMLLS) the importance of structured implementation plans, providing education and a stepwise introduction of LLS, was stressed.…”

Enhanced recovery protocol in laparoscopic liver surgery

“…Clear superiority of ERP over standard protocols in various abdominal operations make well powered randomized controlled trials (RCT) ethically questionable also for LLS. In addition, recently it has turned out that it is challenging to recruit enough liver surgery patients even within multicentre studies for double-blind RCT [7].…”