A prospective study of laparoscopic liver resections was undertaken in patients with preoperative diagnoses that included benign lesions, hepatocellular carcinoma with compensated cirrhosis, and metastasis of non-colorectal origin.
Hepatic involvement was limited and located in the left or peripheral right segments (segments 2-6), and the tumor had to be 5 cm or smaller.
Surgical technique included CO2 pneumoperitoneum and liver transection with a harmonic scalpel, with or without portal triad clamping or hepatic vein control. Portal pedicles and large hepatic veins were stapled.
Resected specimens were placed in a bag and removed through a separate incision, without fragmentation.
18 benign lesions and 12 malignant tumors resected
From May 1996 to December 1999, 19% of 159 liver resections were included in the study.
The group resected 18 benign lesions and 12 malignant tumors, including 8 hepatocellular carcinomas in cirrhotic patients. Mean tumor size was 4.25 cm.
There were two conversions to laparotomy (6.6%). The resections included 1 left hepatectomy, 8 bisegmentectomies (2 and 3), 9 segmentectomies and 11 atypical resections.
Mean blood loss was 300ml. Mean surgical time was 214 minutes. There were no deaths, however complications occurred in six patients (20%). Only one cirrhotic patient developed postoperative ascites. No port-site metastases were observed in patients with malignant disease.
Dr Daniel Cherqui a member of the group, concluded that, "Laparoscopic resections are feasible and safe in selected patients with left-sided and right-peripheral lesions requiring limited resection. Young patients with benign disease clearly benefit from avoiding a major abdominal incision, and cirrhotic patients may have a reduced complication rate."