Surgical Endoscopy

, Volume 27, Issue 8, pp 2721–2726 | Cite as

Laparoscopic left hemihepatectomy a consideration for acceptance as standard of care

  • Giulio Belli
  • Brice Gayet
  • Ho-Seong Han
  • Go Wakabayashi
  • Ki-hun Kim
  • Robert Cannon
  • Hironori Kaneko
  • Thomas Gamblin
  • Alan Koffron
  • Ibrahim Dagher
  • Joseph F. Buell
  • International Consensus Group for Laparoscopic Liver Surgery



Since the inception of laparoscopic liver surgery, the left-lateral sectionectomy has become the standard of care for resection of lesions located in segments II and III. However, few centers employee laparoscopic left hemihepatectomy on a routine basis. This study evaluated the safety and efficacy of the laparoscopic left hemihepatectomy as a standard of care.


An international database of 1,620 laparoscopic liver resections was established and outcomes analyzed comparing the laparoscopic left lateral sectionectomy (L lat) to laparoscopic left hemihepatectomy (LH). All data are presented as mean ± standard deviation.


A total of 222 laparoscopic L lat and 82 LH were identified. The L lat group compared with LH group had a higher incidence of cirrhosis (27 vs. 21 %; p = 0.003) and cancer (48 vs. 35 %; p = 0.043). Tumors were larger in the LH group (7.09 ± 4.2 vs. 4.89 ± 3.1 cm; p = 0.001). Operating time for LH was longer than L lat (3.9 ± 2.3 vs. 2.9 ± 1.4 h; p < 0.001). Operative blood loss was higher in LH (306 vs. 198 cc; p = 0.003). Patient morbidity (20 vs. 18 %; p = 0.765) was equivalent with a longer length of stay (7.1 ± 5.1 vs. 2.5 ± 2.3 days; p < 0.001) for LH. Patient mortality and tumor recurrence were equivalent.


Laparoscopic left hemihepatectomy is a more technically challenging and often time-consuming procedure than a left-lateral sectionectomy. This international multi-institutional confirmed that intraoperative blood loss, complications, and conversions are more than acceptable for laparoscopic left hemihepatectomy in expert hands. Postoperative morbidity and mortality rates together with adequate surgical margins and long-term recurrence are not compromised by the laparoscopic approach.


Hemihepatectomy Left liver Laparoscopic resection 



Prof. Giulio Belli, Prof. Brice Gayet, Prof. Ho-Seong Ha, Prof. Go Wakabayash,Prof Ki-hun Kim, Prof Robert Cannon, Prof. Hironori Kaneko, Prof Thomas Gamblin, Prof Alan Koffron,Prof Ibrahim Dagher, and Prof Joseph F. Buell have no conflicts of interest or financial ties to disclose.


  1. 1.
    Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS, World Consensus Conference on Laparoscopic Surgery (2008) The international position on laparoscopic liver surgery: The Louisville Statement. Ann Surg 250(5):825–830CrossRefGoogle Scholar
  2. 2.
    Vibert E, Perniceni T, Levard H, Denet C, Shahri NK, Gayet B (2006) Laparoscopic liver resection. Br J Surg 93(1):67–72PubMedCrossRefGoogle Scholar
  3. 3.
    Sasaki A, Nitta H, Otsuka K, Takahara T, Nishizuka S, Wakabayashi G (2009) Ten-year experience of totally laparoscopic liver resection in a single institution. Br J Surg 96(3):274–279PubMedCrossRefGoogle Scholar
  4. 4.
    Kim KH, Jung DH, Park KM, Lee YJ, Kim DY, Kim KM, Lee SG (2011) Comparison of open and laparoscopic live donor left lateral sectionectomy. Br J Surg 98(9):1302–1308PubMedCrossRefGoogle Scholar
  5. 5.
    Cannon RM, Brock GN, Marvin MR, Buell JF (2011) Laparoscopic liver resection: an examination of our first 300 patients. J Am Coll Surg 213(4):501–507PubMedCrossRefGoogle Scholar
  6. 6.
    Kaneko H, Takagi S, Shiba T (1996) Laparoscopic partial hepatectomy and left lateral segmentectomy: technique and results of a clinical series. Surgery 120(3):468–475PubMedCrossRefGoogle Scholar
  7. 7.
    Koffron A, Geller D, Gamblin TC, Abecassis M (2006) Laparoscopic liver surgery: shifting the management of liver tumors. Hepatology 44(6):1694–1700PubMedCrossRefGoogle Scholar
  8. 8.
    Belli G, Fantini C, D’Agostino A, Cioffi L, Langella S, Russolillo N, Belli A (2007) Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results. Surg Endosc 21(11):2004–2011PubMedCrossRefGoogle Scholar
  9. 9.
    Cai XJ, Yang J, Yu H, Liang X, Wang YF, Zhu ZY, Peng SY (2008) Clinical study of laparoscopic versus open hepatectomy for malignant liver tumors. Surg Endosc 22(11):2350–2356PubMedCrossRefGoogle Scholar
  10. 10.
    Topal B, Fieuws S, Aerts R, Vandeweyer H, Penninckx F (2008) Laparoscopic versus open liver resection of hepatic neoplasms: comparative analysis of short-term results. Surg Endosc 22(10):2208–2213PubMedCrossRefGoogle Scholar
  11. 11.
    Polignano FM, Quyn AJ, de Figueiredo RS, Henderson NA, Kulli C, Tait IS (2008) Laparoscopic versus open liver segmentectomy: prospective, case-matched, intention-to-treat analysis of clinical outcomes and cost effectiveness. Surg Endosc 22(12):2564–2570PubMedCrossRefGoogle Scholar
  12. 12.
    Belli G, Cioffi L, Fantini C, D’Agostino A, Russo G, Limongelli P, Belli A (2009) Laparoscopic redo surgery for recurrent hepatocellular carcinoma in cirrhotic patients: feasibility, safety, and results. Surg Endosc 23(8):1807–1811PubMedCrossRefGoogle Scholar
  13. 13.
    Lesurtel M, Cherqui D, Laurent A, Tayar C, Fagniez PL (2003) Laparoscopic versus open left lateral hepatic lobectomy: a case-control study. J Am Coll Surg 196(2):236–242PubMedCrossRefGoogle Scholar
  14. 14.
    Aldrighetti L, Pulitanò C, Catena M, Arru M, Guzzetti E, Casati M, Comotti L, Ferla G (2008) A prospective evaluation of laparoscopic versus open left lateral hepatic sectionectomy. J Gastrointest Surg 12(3):457–462PubMedCrossRefGoogle Scholar
  15. 15.
    Dagher I, O’Rourke N, Geller DA, Cherqui D, Belli G, Gamblin TC, Lainas P, Laurent A, Nguyen KT, Marvin MR, Thomas M, Ravindra K, Fielding G, Franco D, Buell JF (2009) Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg 250(5):856–860PubMedCrossRefGoogle Scholar
  16. 16.
    Machado MA, Makdissi FF, Herman P, Surjan RC (2010) Intrahepatic Glissonian approach for pure laparoscopic left hemihepatectomy. J Laparoendosc Adv Surg Tech A 20(2):141–142PubMedCrossRefGoogle Scholar
  17. 17.
    Gumbs AA, Gayet B (2007) Totally laparoscopic left hepatectomy. Surg Endosc 21(7):1221PubMedCrossRefGoogle Scholar
  18. 18.
    Belli G, Fantini C, D’Agostino A, Cioffi L, Limongelli P, Russo G, Belli A (2008) Laparoscopic segment VI liver resection using a left lateral decubitus position: a personal modified technique. J Gastrointest Surg 12(12):2221–2226PubMedCrossRefGoogle Scholar
  19. 19.
    Han HS, Yoon YS, Cho JY, Ahn KS (2010) Laparoscopic right hemihepatectomy for hepatocellular carcinoma. Ann Surg Oncol 17(8):2090–2091PubMedCrossRefGoogle Scholar
  20. 20.
    Cai XJ, Wang YF, Liang YL, Yu H, Liang X (2009) Laparoscopic left hemihepatectomy: a safety and feasibility study of 19 cases. Surg Endosc 23(11):2556–2562PubMedCrossRefGoogle Scholar
  21. 21.
    Schroeder RA, Marroquin CE, Bute BP, Khuri S, Henderson WG, Kuo PC (2006) Predictive indices of morbidity and mortality after liver resection. Ann Surg 243(3):373–379PubMedCrossRefGoogle Scholar
  22. 22.
    Belli G, Limongelli P, Fantini C, D’Agostino A, Cioffi L, Belli A, Russo G (2009) Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis. Br J Surg 96:1041–1048PubMedCrossRefGoogle Scholar
  23. 23.
    Tzanis D, Shivathirthan N, Laurent A, Abu Hilal M, Soubrane O, Kazaryan AM, Ettore GM, Van Dam RM, Lainas P, Tranchart H, Edwin B, Belli G, Campos RR, Pearce N, Gayet B, Dagher I (2012) European experience of laparoscopic major hepatectomy. J Hepatobiliary Pancreat Sci. doi: 10.1007/s00534-012-0554-2 Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Giulio Belli
    • 1
  • Brice Gayet
    • 2
  • Ho-Seong Han
    • 3
  • Go Wakabayashi
    • 4
  • Ki-hun Kim
    • 5
  • Robert Cannon
    • 6
  • Hironori Kaneko
    • 7
  • Thomas Gamblin
    • 8
  • Alan Koffron
    • 9
  • Ibrahim Dagher
    • 10
  • Joseph F. Buell
    • 11
  • International Consensus Group for Laparoscopic Liver Surgery
  1. 1.S. Maria Loreto Nuovo Hospital, General and Hepato-Pancreato-Biliary SurgeryNaplesItaly
  2. 2.Department of Digestive Diseases, Institut Mutualiste MontsourisUniversity Paris VParisFrance
  3. 3.Department of SurgerySeoul National University Bundang HospitalSeoulKorea
  4. 4.Iwate Medical University, Surgery Keio UniversityTokyoJapan
  5. 5.Division of Hepatobiliary Surgery and Liver TransplantationUniversity of Ulsan College of Medicine and Asan Medical CentreSongpa-gu, SeoulKorea
  6. 6.Division of Surgical Oncology, Department of SurgeryUniversity of LouisvilleLouisvilleUSA
  7. 7.Department of SurgeryToho University School of MedicineTokyoJapan
  8. 8.Division of Surgical OncologyMedical College of WisconsinMilwaukeeUSA
  9. 9.William Beaumont HospitalChicagoUSA
  10. 10.Department of Digestive and Minimally Invasive Surgery, AP-HPAntoine Béclère HospitalClamartFrance
  11. 11.Department of SurgeryTulane University School of MedicineNew OrleansUSA

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