Abstract
More than 3,000 laparoscopic liver resections (LLR) are performed worldwide for benign disease, malignancy, and living donor hepatectomy. Minimally invasive hepatic resection approaches include pure laparoscopic, hand-assisted laparoscopic, and a laparoscopic-assisted open “hybrid” approach, where the operation is started laparoscopically to mobilize the liver and begin the dissection, followed by a small laparotomy for completion of the parenchymal transection. Surgeons should have an advanced understanding of hepatic anatomy, extensive experience in open liver surgery, and technical skill to control major vascular and biliary structures laparoscopically before embarking on LLR. Although there is no absolute size criterion, smaller, peripheral lesions (<5 cm) that lie far from major vessels and anticipated transection planes are most amenable to LLR. Although the majority of reported LLR are non-anatomic resections or segmentectomies, several surgical groups are now performing laparoscopic major hepatic resections with excellent safety profiles. Patient benefits from LLR include less operative blood loss, less postoperative pain and narcotic requirement, and a shorter length of hospital stay, with comparable postoperative morbidity and mortality to open liver resection. Comparison studies between LLR and open resection have revealed no differences in width of resection margins for malignant lesions or overall survival after resection for hepatocellular cancer or colorectal cancer liver metastases. Advantages of LLR for HCC in particular include avoidance of collateral vessel ligation, decreased postoperative hepatic insufficiency, and fewer postoperative adhesions, all of which are features that enhance subsequent liver transplantation.
Similar content being viewed by others
References
Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection-2,804 patients. Ann Surg 250:831–841
Gagner M, Rheault M, Dubuc J (1992) Laparoscopic partial hepatectomy for liver tumor. Surg Endosc 6:99
Azagra JS, Goergen M, Gilbart E et al (1996) Laparoscopic anatomical (hepatic) left lateral segmentectomy—technical aspects. Surg Endosc 10:758–761
Nguyen KT, Marsh JW, Tsung A et al (2010) Comparative benefits of laparoscopic versus open hepatic resection: a critical appraisal. Arch Surg. doi:10.1001/archsurg.2010.248
Descottes B, Glineur D, Lachachi F et al (2003) Laparoscopic liver resection of benign liver tumors. Surg Endosc 17:23–30
Gamblin TC, Holloway SE, Heckman JT et al (2008) Laparoscopic resection of benign hepatic cysts: a new standard. J Am Coll Surg 207:731–736
Cho SW, Marsh JW, Steel J et al (2008) Surgical management of hepatocellular adenoma: take it or leave it? Ann Surg Oncol 15:2795–2803
Nguyen KT, Gamblin TC, Geller DA (2008) Laparoscopic liver resection for cancer. Futur Oncol 4:661–670
Sasaki A, Nitta H, Otsuka K et al (2009) Ten-year experience of totally laparoscopic liver resection in a single institution. Br J Surg 96:274–279
Gigot JF, Glineur D, Santiago Azagra J et al (2002) Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study. Ann Surg 236:90–97
Kazaryan AM, Mavango IP, Rosok BI et al (2010) Laparoscopic resection of colorectal liver metastases: surgical and long-term outcomes. Ann Surg 252:1005–1012
Koffron A, Geller D, Gamblin TC et al (2006) Laparoscopic liver surgery: shifting the management of liver tumors. Hepatology 44:1694–1700
Buell JF, Cherqui D, Geller DA et al (2009) The international position on laparoscopic liver surgery: the Louisville statement, 2008. Ann Surg 250:825–830
Koffron AJ, Kung R, Baker T et al (2006) Laparoscopic-assisted right lobe donor hepatectomy. Am J Transpl 6:2522–2525
O’Rourke N, Fielding G (2004) Laparoscopic right hepatectomy: surgical technique. J Gastrointest Surg 8:213–216
Dagher I, O’Rourke N, Geller DA (2009) Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg 250:856–860
Dagher I, Di Giuro G, Dubrez J et al (2009) Laparoscopic versus open right hepatectomy: a comparative study. Am J Surg 198:173–177
Gayet B, Cavaliere D, Vibert E et al (2007) Totally laparoscopic right hepatectomy. Am J Surg 194:685–689
Nitta N, Sasaki A, Fujita T et al (2010) Laparoscopy-assisted major liver resections employing a hanging maneuver. Ann Surg 251:450–453
Kazaryan AM, Pavlik Marangos I, Rosseland AR et al (2010) Laparoscopic liver resection for malignant and benign lesions: ten-year Norwegian single-center experience. Arch Surg 145:34–40
Cherqui D, Laurent A, Tayar C et al (2006) Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives. Ann Surg 243:499–506
Cherqui D, Soubrane O, Husson E et al (2002) Laparoscopic living donor hepatectomy for liver transplantation in children. Lancet 359:392–396
Soubrane O, Cherqui D, Scatton O et al (2006) Laparoscopic left lateral sectionectomy in living donors: safety and reproducibility of the technique in a single center. Ann Surg 244:815–820
Kurosaki I, Yamamoto S, Kitami C et al (2006) Video-assisted living donor hemihepatectomy through a 12-cm incision for adult-to-adult liver transplantation. Surgery 139:695–703
Yoon YS, Han HS, Cho JS et al (2010) Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver. Surg Endosc 24:1630–1637
Vigano L, Laurent A, Tayar C et al (2009) The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg 250:772–782
Koffron AJ, Auffenberg G, Kung R et al (2007) Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg 246:385–392
Ito K, Ito H, Are C et al (2009) Laparoscopic versus open liver resection: a matched-pair case control study. J Gastrointest Surg 3:2276–2283
Tsinberg M, Tellioglu G, Simpfendorfer CH et al (2009) Comparison of laparoscopic versus open liver tumor resection: a case-controlled study. Surg Endosc 23:847–853
Sarpel U, Hefti MM, Wisnievsky JP et al (2009) Outcome for patients treated with laparoscopic versus open resection of hepatocellular carcinoma: case-matched analysis. Ann Surg Oncol 16:1572–1577
Rowe AJ, Meneghetti AT, Schumacher PA et al (2009) Perioperative analysis of laparoscopic versus open liver resection. Surg Endosc 23:1198–1203
Buell JF, Thomas MJ, Doty TC et al (2004) An initial experience and evolution of laparoscopic hepatic resectional surgery. Surgery 136:804–811
Topal B, Fieuws S, Aerts R et al (2008) Laparoscopic versus open liver resection of hepatic neoplasms: comparative analysis of short-term results. Surg Endosc 22:2208–2213
Castaing D, Vibert E, Ricca L et al (2009) Oncologic results of laparoscopic versus open hepatectomy for colorectal liver metastases in two specialized centers. Ann Surg 250:849–855
Belli G, Limongelli P, Fantini C et al (2009) Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis. Br J Surg 96:1041–1048
Tranchart H, Di Giuro G, Lainas P et al (2010) Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 24:1170–1176
Morino M, Morra I, Rosso E et al (2003) Laparoscopic vs open hepatic resection: a comparative study. Surg Endosc 17:1914–1918
Polignano FM, Quyn AJ, de Figueiredo RS et al (2008) Laparoscopic versus open liver segmentectomy: prospective, case-matched, intention-to-treat analysis of clinical outcomes and cost effectiveness. Surg Endosc 22:2564–2570
Abu Hilal M, McPhail MJ, Zeidan B et al (2008) Laparoscopic versus open left lateral hepatic sectionectomy: a comparative study. Eur J Surg Oncol 34:1285–1288
Belli G, Fantini C, D’ Agostino A et al (2007) Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results. Surg Endosc 21:2004–2011
Farges O, Jagot P, Kirstetter P et al (2002) Prospective assessment of the safety and benefit of laparoscopic liver resections. J Hepatobiliary Pancreat Surg 9:242–248
Aldrighetti L, Pulitanò C, Catena M et al (2008) A prospective evaluation of laparoscopic versus open left lateral hepatic sectionectomy. J Gastrointest Surg 12:457–462
Troisi R, Montalti R, Smeets P et al (2008) The value of laparoscopic liver surgery for solid benign hepatic tumors. Surg Endosc 22:38–44
Lesurtel M, Cherqui D, Laurent A et al (2003) Laparoscopic versus open left lateral hepatic lobectomy: a case-control study. J Am Coll Surg 196:236–242
Rau HG, Buttler E, Meyer G et al (1998) Laparoscopic liver resection compared with conventional partial hepatectomy—a prospective analysis. Hepatogastroenterology 45:2333–2338
Mala T, Edwin B, Gladhaug I et al (2002) A comparative study of the short-term outcome following open and laparoscopic liver resection of colorectal metastases. Surg Endosc 16:1059–1063
Laurent A, Cherqui D, Lesurtel M et al (2003) Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg 138:763–769
Cai X, Wang Y, Yu H et al (2007) Laparoscopic hepatectomy for hepatolithiasis: a feasibility and safety study in 29 patients. Surg Endosc 21:1074–1078
Kaneko H, Takagi S, Otsuka Y et al (2005) Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg 189:190–194
Cai XJ, Yang J, Yu H et al (2008) Clinical study of laparoscopic versus open hepatectomy for malignant liver tumors. Surg Endosc 22:2350–2356
Lai EC, Tang CN, Ha JP et al (2009) Laparoscopic liver resection for hepatocellular carcinoma: ten-year experience in a single center. Arch Surg 144:143–147
Lee KF, Cheung YS, Chong CN et al (2007) Laparoscopic versus open hepatectomy for liver tumours: a case control study. Hong Kong Med J 13:442–448
Shimada M, Hashizume M, Maehara S et al (2001) Laparoscopic hepatectomy for hepatocellular carcinoma. Surg Endosc 15:541–544
Endo Y, Ohta M, Sasaki A et al. A comparative study of the long-term outcomes after laparoscopy-assisted and open left lateral hepatectomy for hepatocellular carcinoma. Surg Laparosc Endosc Percutan Tech 19:e171–e174
Tang CN, Li MK (2003) Hand-assisted laparoscopic segmentectomy in recurrent pyogenic cholangitis. Surg Endosc 17:324–327
Mamada Y, Yoshida H, Taniai N et al (2007) Usefulness of laparoscopic hepatectomy. J Nippon Med Sch 74:158–162
Simillis C, Constantinides VA, Tekkis PP et al (2007) Laparoscopic versus open hepatic resections for benign and malignant neoplasms—a meta-analysis. Surgery 141:203–211
Laurent A, Tayar C, Andreoletti M et al (2009) Laparoscopic liver resection facilitates salvage liver transplantation for hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 16:310–314
Dagher I, Belli G, Fantini C et al (2010) Laparoscopic hepatectomy for hepatocellular carcinoma: a European experience. J Am Coll Surg 211:16–23
Chen HY, Juan CC, Ker CG (2008) Laparoscopic liver surgery for patients with hepatocellular carcinoma. Ann Surg Oncol 15:800–806
Nguyen KT, Laurent A, Dagher I et al (2009) Minimally invasive liver resection for metastatic colorectal cancer: a multi-institutional international report of safety, feasibility, and early outcomes. Ann Surg 250:842–848
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Reddy, S.K., Tsung, A. & Geller, D.A. Laparoscopic Liver Resection. World J Surg 35, 1478–1486 (2011). https://doi.org/10.1007/s00268-010-0906-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-010-0906-5