Laparoscopic liver resection
- Timothy M Pawlik, MD, MPH, PhD, FACS, RACS (Hon.)
Timothy M Pawlik, MD, MPH, PhD, FACS, RACS (Hon.)
- Professor and Chair, Department of Surgery
- Professor of Surgery, Oncology, and Health Services Management and Policy
- The Ohio State University, Wexner Medical Center
- Carl Schmidt, MD
Carl Schmidt, MD
- Associate Professor of Surgery
- The Ohio State University
- Heather L Lewis, MD
Heather L Lewis, MD
- Surgical Oncology Fellow
- The Ohio State University
Since the first reports of laparoscopic liver resection (LLR) in the early 1990s [1,2], its development and adoption have lagged behind those of other laparoscopic procedures due to technical challenges and fewer patients requiring liver surgery compared with other procedures. In 2008, the first international consensus meeting established the feasibility and safety of LLR and defined its indications .
The subsequent decade saw an increase in the overall number of liver surgeries performed and an exponential growth in LLR [4,5]. A 2016 review documented close to 10,000 procedures of LLR performed worldwide . The technical expertise associated with LLR has also improved as more procedures were performed [3,6,7].
The use of LLR for minor hepatectomy has increased more rapidly than that for major hepatectomy . In 2014, a second consensus conference concluded that LLR had become standard practice for minor hepatectomy but remained "exploratory" for major hepatectomy . However, these recommendations were made based on low-quality evidence, as no randomized trial has been performed to compare LLR with its open counterpart.
In this topic, we review the indications, patient selection, learning curve, surgical techniques, and outcomes of LLR. Other aspects of liver surgery, such as preoperative imaging to determine future liver remnant and techniques for open liver resection (OLR), are discussed in other topics. (See "Overview of hepatic resection" and "Hepatic resection techniques" and "Surgical management of potentially resectable hepatocellular carcinoma".)
LLR is performed with the same objectives as open liver resection (OLR), namely to remove malignant and benign lesions of the liver. Worldwide, 35 percent of LLRs are performed for benign conditions, while the other 65 percent are performed for primary and secondary malignant liver tumors (table 1) [5,7]. (See "Overview of hepatic resection", section on 'Indications for hepatic resection'.)
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- Malignant tumors
- Benign conditions
- PATIENT SELECTION
- LEARNING CURVE
- SURGICAL TECHNIQUES
- Patient positioning
- Peritoneal access
- Laparoscopic and ultrasound exploration
- Mobilization of liver
- Vascular control
- - Inflow control
- - Outflow control
- Parenchymal transection
- Specimen extraction and closing
- COMMONLY PERFORMED PROCEDURES
- Laparoscopic right hepatectomy
- Laparoscopic left hepatectomy
- Laparoscopic left lateral segmentectomy
- Mortality and morbidity
- Comparison with open liver resection
- - Technical performance
- - Short-term outcomes
- - Long-term (oncologic) outcomes
- SUMMARY AND RECOMMENDATIONS