Journal of Gastrointestinal Surgery

, Volume 12, Issue 3, pp 457–462 | Cite as

A Prospective Evaluation of Laparoscopic Versus Open Left Lateral Hepatic Sectionectomy

  • Luca Aldrighetti
  • Carlo Pulitanò
  • Marco Catena
  • Marcella Arru
  • Eleonora Guzzetti
  • Massimiliano Casati
  • Laura Comotti
  • Gianfranco Ferla
Article

Abstract

Background

Left lateral sectionectomy is one of the most commonly performed laparoscopic liver resections, but limited clinical data are actually available to support the advantage of laparoscopic versus open-liver surgery. The present study compared the short-term outcomes of laparoscopic versus open surgery in a case-matched analysis.

Materials and Methods

Surgical outcome of 20 patients who underwent left lateral sectionectomy by laparoscopic approach (LHR group) from September 2005 to January 2007 were compared in a case-control analysis with those of 20 patients who underwent open left lateral sectionectomy (OHR group). Both groups were similar for: tumor size, preoperative laboratory data, presence of cirrhosis, and histology of the lesion. Surgical procedures were performed in both groups combining the ultrasonic dissector and the ultrasonic coagulating cutter without portal clamping.

Results

Compared with OHR, the LHR group had a decreased blood loss (165 mL versus 214 mL, P = 0.001), and earlier postoperative recovery (4.5 versus 5.8 days, P = 0.003). There were no significant differences in terms of surgical margin and operative time. Morbidity was comparable between the two groups, but two cases of postoperative ascites were recorded in two cirrhotic patients in the OHR. Major complications were not observed in either groups.

Conclusions

Laparoscopic resection results in reduced operative blood loss and earlier recovery with oncologic clearance and operative time comparable with open surgery. Laparoscopic liver surgery may be considered the approach of choice for tumors located in the left hepatic lobe.

Keywords

Liver surgery Laparoscopic liver resection Ultrasonic dissector Ultrasonic coagulating cutter 

References

  1. 1.
    Chang S, Laurent A, Tayar C, Karoui M, Cherqui D. Laparoscopy as a routine approach for left lateral sectionectomy. Br J Surg 2007;94(1):58–63.PubMedCrossRefGoogle Scholar
  2. 2.
    Soubrane O, Cherqui D, Scatton O, Stenard F, Bernard D, Branchereau S, Martelli H, Gauthier F. Laparoscopic left lateral sectionectomy in living donors: safety and reproducibility of the technique in a single center. Ann Surg 2006;244(5):815–820.PubMedCrossRefGoogle Scholar
  3. 3.
    Vibert E, Perniceni T, Levard H, Denet C, Shahri NK, Gayet B. Laparoscopic liver resection. Br J Surg 2006;93:67–72.PubMedCrossRefGoogle Scholar
  4. 4.
    Buell JF, Thomas MJ, Doty TC, Gersin KS, Merchen TD, Gupta M, Rudich SM, Woodle ES. An initial experience and evolution of laparoscopic hepatic resectional surgery. Surgery 2004;136(4):804–811.PubMedCrossRefGoogle Scholar
  5. 5.
    Morino M, Morra I, Rosso E, Miglietta C, Garrone C. Laparoscopic vs open hepatic resection: a comparative study. Surg Endosc 2003;17(12):1914–1918.PubMedCrossRefGoogle Scholar
  6. 6.
    Kaneko H, Takagi S, Shiba T. Laparoscopic partial hepatectomy and left lateral segmentectomy: technique and results of a clinical series. Surgery 1996;120(3):468–475.PubMedCrossRefGoogle Scholar
  7. 7.
    Mala T, Edwin B, Gladhaug I, Fosse E, Soreide O, Bergan A, Mathisen O. A comparative study of the short-term outcome following open and laparoscopic liver resection of colorectal metastases. Surg Endosc 2002;16(7):1059–1063.PubMedCrossRefGoogle Scholar
  8. 8.
    Farges O, Jagot P, Kirstetter P, Marty J, Belghiti J. Prospective assessment of the safety and benefit of laparoscopic liver resections. J Hepatobiliary Pancreat Surg 2002;9(2):242–248.PubMedCrossRefGoogle Scholar
  9. 9.
    Laurent A, Cherqui D, Lesurtel M, Brunetti F, Tayar C, Fagniez PL. Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg 2003;138(7):763–769; discussion 769.PubMedCrossRefGoogle Scholar
  10. 10.
    Kaneko H, Takagi S, Otsuka Y, Tsuchiya M, Tamura A, Katagiri T, Maeda T, Shiba T. Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg 2005;189(2):190–194.PubMedCrossRefGoogle Scholar
  11. 11.
    Aldrighetti L, Pulitano C, Arru M, Catena M, Finazzi R, Ferla G. "Technological" approach versus clamp crushing technique for hepatic parenchymal transection: a comparative study. J Gastrointest Surg 2006;10(7):974–979.PubMedCrossRefGoogle Scholar
  12. 12.
    Arru M, Pulitano C, Aldrighetti L, Catena M, Finazzi R, Ferla G. A prospective evaluation of ultrasonic dissector plus harmonic scalpel in liver resection. Am Surg 2007 Mar;73(3):256–260.PubMedGoogle Scholar
  13. 13.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240(2):205–213.PubMedCrossRefGoogle Scholar
  14. 14.
    Rau HG, Buttler E, Meyer G, Schardey HM, Schildberg FW. Laparoscopic liver resection compared with conventional partial hepatectomy—a prospective analysis. Hepatogastroenterology 1998;45(24):2333–2338.PubMedGoogle Scholar
  15. 15.
    Lesurtel M, Cherqui D, Laurent A, Tayar C, Fagniez PL. Laparoscopic versus open left lateral hepatic lobectomy: a case-control study. J Am Coll Surg 2003;196(2):236–242.PubMedCrossRefGoogle Scholar
  16. 16.
    Gigot J-F, Glineur D, Azagra JS, Goergen M, Ceuterick M, Morino M, Etienne J, Marescaux J, Mutter D, van Krunckelsven L, Descottes B, Valleix D, Lachachi F, Bertrand L, Mansvelt B, Hubens G, Saey JP, Schockmel R. Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study. Ann Surg 2002;236:90–97.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Luca Aldrighetti
    • 1
  • Carlo Pulitanò
    • 1
  • Marco Catena
    • 1
  • Marcella Arru
    • 1
  • Eleonora Guzzetti
    • 1
  • Massimiliano Casati
    • 1
  • Laura Comotti
    • 2
  • Gianfranco Ferla
    • 1
  1. 1.Department of Surgery—Liver UnitScientific Institute San Raffaele, Vita-Salute San Raffaele UniversityMilanItaly
  2. 2.Department of AnesthesiologyScientific Institute San Raffaele, Vita-Salute San Raffaele UniversityMilanItaly

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