Surgical Endoscopy

, Volume 31, Issue 3, pp 1442–1450 | Cite as

Clinical impact of laparoscopic hepatectomy: technical and oncological viewpoints

  • Shohei Komatsu
  • Raffaele Brustia
  • Claire Goumard
  • Ailton Sepulveda
  • Fabiano Perdigao
  • Olivier Soubrane
  • Olivier Scatton


The objective of this study was to assess the clinical impact of laparoscopic hepatectomy from technical and oncological viewpoints through the consecutive 5-year experience of an expert team. The subjects consisted of 491 consecutive hepatectomies performed over the course of 5 years. A total of 190 hepatectomies (38.6 %) were performed laparoscopically, and the remaining 301 (61.4 %) were open hepatectomies. Chronological trends of operative procedures and their indications were evaluated, and patients with hepatocellular carcinoma (HCC) were analyzed from an oncological viewpoint. The proportion of laparoscopic hepatectomies performed increased significantly during the study period (from 17.6 to 49.5 %). According to chronological trends, right hepatectomy was standardized using consecutive steps after minor hepatectomy, left lateral sectionectomy, and left hepatectomy were standardized. The proportion of laparoscopic hepatectomies performed for HCC increased from 21.4 to 71.0 %. No significant difference was observed in the proportion of major hepatectomies performed for HCC between the open and laparoscopy groups (50.6 vs. 48.6 %, p = 0.8053), whereas that of anatomical segmentectomy for HCC was significantly lower in the laparoscopy group (28.7 vs. 11.1 %, p = 0.0064). All laparoscopic anatomical segmentectomies were of segments 5 and 6, and there was no segmentectomy of posterosuperior lesions. The present study shows the consecutive technical developmental processes for minor hepatectomy, left lateral sectionectomy, left hepatectomy, and right hepatectomy without compromising oncological principles. Laparoscopic anatomical segmentectomy for posterosuperior lesions may be the most technically demanding procedure, requiring individualized standardization.


Hepatocellular carcinoma Laparoscopic hepatectomy Anatomical segmentectomy Left lateral sectionectomy Major hepatectomy Standardization 


Compliance with ethical standards


Drs. Shohei Komatsu, Raffaele Brustia, Claire Goumard, Ailton Sepulveda, Fabiano Perdigao, Olivier Soubrane, and Olivier Scatton have no conflict of interests or financial ties to disclose.


  1. 1.
    Vigano L, Laurent A, Tayar C, Tomatis M, Ponti A, Cherqui D (2009) The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg 250:772–782CrossRefPubMedGoogle Scholar
  2. 2.
    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 250:856–860CrossRefPubMedGoogle Scholar
  3. 3.
    Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, Hasegawa Y, Katagiri T, Takagi C, Itano O, Kaneko H, Wakabayashi G (2014) A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci 21:745–753CrossRefPubMedGoogle Scholar
  4. 4.
    Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schon MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261:619–629PubMedGoogle Scholar
  5. 5.
    Cherqui D, Soubrane O, Husson E, Barshasz E, Vignaux O, Ghimouz M, Branchereau S, Chardot C, Gauthier F, Fagniez PL, Houssin D (2002) Laparoscopic living donor hepatectomy for liver transplantation in children. Lancet 359:392–396CrossRefPubMedGoogle Scholar
  6. 6.
    Soubrane O, Cherqui D, Scatton O, Stenard F, Bernard D, Branchereau S, Martelli H, Gauthier F (2006) Laparoscopic left lateral sectionectomy in living donors: safety and reproducibility of the technique in a single center. Ann Surg 244:815–820CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Costi R, Scatton O, Haddad L, Randone B, Andraus W, Massault PP, Soubrane O (2012) Lessons learned from the first 100 laparoscopic liver resections: not delaying conversion may allow reduced blood loss and operative time. J Laparoendosc Adv Surg Tech A 22:425–431CrossRefPubMedGoogle Scholar
  8. 8.
    Scatton O, Katsanos G, Boillot O, Goumard C, Bernard D, Stenard F, Perdigao F, Soubrane O (2015) Pure laparoscopic left lateral sectionectomy in living donors: from innovation to development in France. Ann Surg 261:506–512CrossRefPubMedGoogle Scholar
  9. 9.
    Soubrane O, Schwarz L, Cauchy F, Perotto LO, Brustia R, Bernard D, Scatton O (2015) A conceptual technique for laparoscopic right hepatectomy based on facts and oncologic principles: the Caudal approach. Ann Surg 261:1226–1231CrossRefPubMedGoogle Scholar
  10. 10.
    Komatsu S, Brustia R, Goumard C, Perdigao F, Soubrane O, Scatton O (2016) Laparoscopic versus open major hepatectomy for hepatocellular carcinoma: a matched pair analysis. Surg Endosc 30:1965–1974CrossRefPubMedGoogle Scholar
  11. 11.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Ikeda T, Toshima T, Harimoto N, Yamashita Y, Ikegami T, Yoshizumi T, Soejima Y, Shirabe K, Maehara Y (2014) Laparoscopic liver resection in the semiprone position for tumors in the anterosuperior and posterior segments, using a novel dual-handling technique and bipolar irrigation system. Surg Endosc 28:2484–2492CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Tranchart H, Di Giuro G, Lainas P, Roudie J, Agostini H, Franco D, Dagher I (2010) Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 24:1170–1176CrossRefPubMedGoogle Scholar
  14. 14.
    Gaillard M, Tranchart H, Dagher I (2014) Laparoscopic liver resections for hepatocellular carcinoma: current role and limitations. World J Gastroenterol 20:4892–4899CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Hasegawa K, Kokudo N, Imamura H, Matsuyama Y, Aoki T, Minagawa M, Sano K, Sugawara Y, Takayama T, Makuuchi M (2005) Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg 242:252–259CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Regimbeau JM, Kianmanesh R, Farges O, Dondero F, Sauvanet A, Belghiti J (2002) Extent of liver resection influences the outcome in patients with cirrhosis and small hepatocellular carcinoma. Surgery 131:311–317CrossRefPubMedGoogle Scholar
  17. 17.
    Chang S, Laurent A, Tayar C, Karoui M, Cherqui D (2007) Laparoscopy as a routine approach for left lateral sectionectomy. Br J Surg 94:58–63CrossRefPubMedGoogle Scholar
  18. 18.
    Belli G, Gayet B, Han HS, Wakabayashi G, Kim KH, Cannon R, Kaneko H, Gamblin T, Koffron A, Dagher I, Buell JF, International Consensus Group for Laparoscopic Liver S (2013) Laparoscopic left hemihepatectomy a consideration for acceptance as standard of care. Surg Endosc 27:2721–2726CrossRefPubMedGoogle Scholar
  19. 19.
    Nomi T, Fuks D, Kawaguchi Y, Mal F, Nakajima Y, Gayet B (2015) Laparoscopic major hepatectomy for colorectal liver metastases in elderly patients: a single-center, case-matched study. Surg Endosc 29:1368–1375CrossRefPubMedGoogle Scholar
  20. 20.
    Dagher I, Lainas P, Carloni A, Caillard C, Champault A, Smadja C, Franco D (2008) Laparoscopic liver resection for hepatocellular carcinoma. Surg Endosc 22:372–378CrossRefPubMedGoogle Scholar
  21. 21.
    Cheung TT, Poon RT, Yuen WK, Chok KS, Jenkins CR, Chan SC, Fan ST, Lo CM (2013) Long-term survival analysis of pure laparoscopic versus open hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a single-center experience. Ann Surg 257:506–511CrossRefPubMedGoogle Scholar
  22. 22.
    Dagher I, Gayet B, Tzanis D, Tranchart H, Fuks D, Soubrane O, Han HS, Kim KH, Cherqui D, O’Rourke N, Troisi RI, Aldrighetti L, Bjorn E, Abu Hilal M, Belli G, Kaneko H, Jarnagin WR, Lin C, Pekolj J, Buell JF, Wakabayashi G (2014) International experience for laparoscopic major liver resection. J Hepatobiliary Pancreat Sci 21:732–736CrossRefPubMedGoogle Scholar
  23. 23.
    Lee W, Han HS, Yoon YS, Cho JY, Choi Y, Shin HK (2014) Role of intercostal trocars on laparoscopic liver resection for tumors in segments 7 and 8. J Hepatobiliary Pancreat Sci 21:E65–E68CrossRefPubMedGoogle Scholar
  24. 24.
    Honda G, Kurata M, Okuda Y, Kobayashi S, Tadano S, Yamaguchi T, Matsumoto H, Nakano D, Takahashi K (2013) Totally laparoscopic hepatectomy exposing the major vessels. J Hepatobiliary Pancreat Sci 20:435–440CrossRefPubMedGoogle Scholar
  25. 25.
    Ishizawa T, Gumbs AA, Kokudo N, Gayet B (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256:959–964CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Shohei Komatsu
    • 1
  • Raffaele Brustia
    • 1
  • Claire Goumard
    • 1
  • Ailton Sepulveda
    • 2
  • Fabiano Perdigao
    • 1
  • Olivier Soubrane
    • 2
  • Olivier Scatton
    • 1
  1. 1.Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de ParisUniversité Pierre et Marie CurieParisFrance
  2. 2.Department of Hepato-Pancreato-Biliary Surgery and Transplantation, Hopital BeaujonUniversité Paris VIIClichy CedexFrance

Personalised recommendations