Skip to main content
SpringerLink
Log in

Safety of Minimally Invasive Laparoscopic Approach in Major Liver Surgery

  • Chapter
  • First Online:
The High-risk Surgical Patient

  • 1415 Accesses

Abstract

Due to inherent peculiarities and difficulties of liver surgery, the minimally invasive approach has spread in this field at a slower pace compared to other surgical specialties. The laparoscopic approach in liver surgery has been associated with an improved postoperative course, including reduced morbidity, intraoperative blood losses, length of hospitalization, and unaltered oncological outcomes. The current consensus guidelines, although mainly based on non-randomized studies, recognize that in expert hands, laparoscopic major hemi-hepatectomies are associated with reduced hospital stay and blood loss, while oncological outcomes are comparable to those of an open approach. Given these advantages, the development of a laparoscopic liver resection program is recommended in every hepatobiliary center.

The use of the robotic platform in liver surgery carries some potential advantages. An enhanced surgical view with a stable camera, tremor filtration, and wristed instruments bring potential advantages to liver surgery by facilitating the dissection of the hepatoduodenal ligament, the hepatocaval confluence and identification and ligation of the structures encountered during parenchymal transection. Liver mobilization is also facilitated by the stable retraction ensured by the fourth robotic arm. To date, non-randomized studies have shown that robotic-assisted liver surgery achieves results comparable to laparoscopy, although the cost-benefit ratio is still unfavorable. However, the robotic platform seems to shorter the learning curve and ease the adoption of minimally invasive techniques by open surgeons.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Reich H, McGlynn F, DeCaprio J, Budin R. Laparoscopic excision of benign liver lesions. Obstet Gynecol. 1991;78(5 Pt 2):956–8.

    CAS  PubMed  Google Scholar 

  2. Cherqui D, Husson E, Hammoud R, et al. Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg. 2000;232(6):753–62. https://doi.org/10.1097/00000658-200012000-00004.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection-2,804 patients. Ann Surg. 2009;250(5):831–41. https://doi.org/10.1097/SLA.0b013e3181b0c4df.

    Article  PubMed  Google Scholar 

  4. Koffron AJ, Auffenberg G, Kung R, Abecassis M. Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg. 2007;246(3):385–92; discussion 392–394. https://doi.org/10.1097/SLA.0b013e318146996c.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Xie SM, Xiong JJ, Liu XT, et al. Laparoscopic versus open liver resection for colorectal liver metastases: a comprehensive systematic review and meta-analysis. Sci Rep. 2017;7(1):1012. https://doi.org/10.1038/s41598-017-00978-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Kabir T, Tan ZZ, Syn NL, et al. Laparoscopic versus open resection of hepatocellular carcinoma in patients with cirrhosis: a meta-analysis. Br J Surg. 2021;109:21–9. https://doi.org/10.1093/bjs/znab376.

    Article  PubMed  Google Scholar 

  7. Troisi RI, Berardi G, Morise Z, et al. Laparoscopic and open liver resection for hepatocellular carcinoma with Child-Pugh B cirrhosis: multicentre propensity score-matched study. Br J Surg. 2021;108(2):196–204. https://doi.org/10.1093/bjs/znaa041.

    Article  CAS  PubMed  Google Scholar 

  8. Fretland ÅA, Dagenborg VJ, Bjørnelv GMW, et al. Laparoscopic versus open resection for colorectal liver metastases: the OSLO-COMET randomized controlled trial. Ann Surg. 2018;267(2):199–207. https://doi.org/10.1097/SLA.0000000000002353.

    Article  PubMed  Google Scholar 

  9. Chan AKC, Jamdar S, Sheen AJ, Siriwardena AK. The OSLO-COMET randomized controlled trial of laparoscopic versus open resection for colorectal liver metastases. Ann Surg. 2018;268:e69. https://doi.org/10.1097/SLA.0000000000002640.

    Article  PubMed  Google Scholar 

  10. Buell JF, Cherqui D, Geller DA, et al. The international position on laparoscopic liver surgery: the Louisville statement, 2008. Ann Surg. 2009;250(5):825–30. https://doi.org/10.1097/sla.0b013e3181b3b2d8.

    Article  PubMed  Google Scholar 

  11. Abu Hilal M, Aldrighetti L, Dagher I, et al. The Southampton consensus guidelines for laparoscopic liver surgery: from indication to implementation. Ann Surg. 2018;268(1):11–8. https://doi.org/10.1097/SLA.0000000000002524.

    Article  PubMed  Google Scholar 

  12. Mullen JT, Ribero D, Reddy SK, et al. Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg. 2007;204(5):854–62; discussion 862–864. https://doi.org/10.1016/j.jamcollsurg.2006.12.032.

    Article  PubMed  Google Scholar 

  13. de Boer MT, Molenaar IQ, Porte RJ. Impact of blood loss on outcome after liver resection. Dig Surg. 2007;24(4):259–64. https://doi.org/10.1159/000103656.

    Article  PubMed  Google Scholar 

  14. Johnson M, Mannar R, Wu AV. Correlation between blood loss and inferior vena caval pressure during liver resection. Br J Surg. 1998;85(2):188–90. https://doi.org/10.1046/j.1365-2168.1998.00570.x.

    Article  CAS  PubMed  Google Scholar 

  15. Jarnagin WR, Gonen M, Maithel SK, et al. A prospective randomized trial of acute normovolemic hemodilution compared to standard intraoperative management in patients undergoing major hepatic resection. Ann Surg. 2008;248(3):360–9. https://doi.org/10.1097/SLA.0b013e318184db08.

    Article  PubMed  Google Scholar 

  16. Otsuka Y, Katagiri T, Ishii J, et al. Gas embolism in laparoscopic hepatectomy: what is the optimal pneumoperitoneal pressure for laparoscopic major hepatectomy? J Hepatobiliary Pancreat Sci. 2013;20(2):137–40. https://doi.org/10.1007/s00534-012-0556-0.

    Article  PubMed  Google Scholar 

  17. Sand L, Rizell M, Houltz E, et al. Effect of patient position and PEEP on hepatic, portal and central venous pressures during liver resection. Acta Anaesthesiol Scand. 2011;55(9):1106–12. https://doi.org/10.1111/j.1399-6576.2011.02502.x.

    Article  CAS  PubMed  Google Scholar 

  18. Yoon YS, Han HS, Cho JY, Ahn KS. Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver. Surg Endosc. 2010;24(7):1630–7. https://doi.org/10.1007/s00464-009-0823-6.

    Article  PubMed  Google Scholar 

  19. Rashidian N, Willaert W, Giglio MC, et al. Laparoscopic liver surgery training course on Thiel-embalmed human cadavers: program evaluation, trainer’s long-term feedback and steps forward. World J Surg. 2019;43(11):2902–8. https://doi.org/10.1007/s00268-019-05103-x.

    Article  PubMed  Google Scholar 

  20. Rashidian N, Willaert W, Van Herzeele I, et al. Key components of a hepatobiliary surgery curriculum for general surgery residents: results of the FULCRUM international Delphi consensus. HPB. 2020;22(10):1429–41. https://doi.org/10.1016/j.hpb.2020.01.011.

    Article  PubMed  Google Scholar 

  21. Celentano V, Smart N, Cahill RA, et al. Development and validation of a recommended checklist for assessment of surgical videos quality: the LAParoscopic surgery video educational GuidelineS (LAP-VEGaS) video assessment tool. Surg Endosc. 2021;35(3):1362–9. https://doi.org/10.1007/s00464-020-07517-4.

    Article  PubMed  Google Scholar 

  22. Tomassini F, Scuderi V, Colman R, Vivarelli M, Montalti R, Troisi RI. The single surgeon learning curve of laparoscopic liver resection: a continuous evolving process through stepwise difficulties. Medicine (Baltimore). 2016;95(43):e5138. https://doi.org/10.1097/MD.0000000000005138.

    Article  PubMed  Google Scholar 

  23. Vigano L, Laurent A, Tayar C, Tomatis M, Ponti A, Cherqui D. The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg. 2009;250(5):772–82. https://doi.org/10.1097/SLA.0b013e3181bd93b2.

    Article  PubMed  Google Scholar 

  24. van der Poel MJ, Besselink MG, Cipriani F, et al. Outcome and learning curve in 159 consecutive patients undergoing total laparoscopic hemihepatectomy. JAMA Surg. 2016;151(10):923–8. https://doi.org/10.1001/jamasurg.2016.1655.

    Article  PubMed  Google Scholar 

  25. Cauchy F, Fuks D, Nomi T, et al. Risk factors and consequences of conversion in laparoscopic major liver resection. Br J Surg. 2015;102(7):785–95. https://doi.org/10.1002/bjs.9806.

    Article  CAS  PubMed  Google Scholar 

  26. Kawaguchi Y, Fuks D, Kokudo N, Gayet B. Difficulty of laparoscopic liver resection: proposal for a new classification. Ann Surg. 2018;267(1):13–7. https://doi.org/10.1097/SLA.0000000000002176.

    Article  PubMed  Google Scholar 

  27. Halls MC, Cipriani F, Berardi G, et al. Conversion for unfavorable intraoperative events results in significantly worse outcomes during laparoscopic liver resection: lessons learned from a multicenter review of 2861 cases. Ann Surg. 2018;268(6):1051–7. https://doi.org/10.1097/SLA.0000000000002332.

    Article  PubMed  Google Scholar 

  28. Ryska M, Fronek J, Rudis J, Jurenka B, Langer D, Pudil J. [Manual and robotic laparoscopic liver resection. Two case-reviews]. Rozhl V Chir Mesicnik Ceskoslovenske Chir Spolecnosti. 2006;85(10):511–516.

    Google Scholar 

  29. Troisi RI, Pegoraro F, Giglio MC, et al. Robotic approach to the liver: open surgery in a closed abdomen or laparoscopic surgery with technical constraints? Surg Oncol. 2020;33:239. https://doi.org/10.1016/j.suronc.2019.10.012.

    Article  PubMed  Google Scholar 

  30. Ciria R, Berardi G, Alconchel F, et al. The impact of robotics in liver surgery: a worldwide systematic review and short-term outcomes meta-analysis on 2,728 cases. J Hepatobiliary Pancreat Sci. 2022;29:181–97. https://doi.org/10.1002/jhbp.869.

    Article  PubMed  Google Scholar 

  31. Giulianotti PC, Tzvetanov I, Jeon H, et al. Robot-assisted right lobe donor hepatectomy. Transplant Int. 2012;25(1):e5–9. https://doi.org/10.1111/j.1432-2277.2011.01373.x.

    Article  Google Scholar 

  32. Hawksworth J, Radkani P, Nguyen B, et al. Improving safety of robotic major hepatectomy with extrahepatic inflow control and laparoscopic CUSA parenchymal transection: technical description and initial experience. Surg Endosc. 2022;36:3270–6. https://doi.org/10.1007/s00464-021-08639-z.

    Article  PubMed  Google Scholar 

  33. Guan R, Chen Y, Yang K, et al. Clinical efficacy of robot-assisted versus laparoscopic liver resection: a meta analysis. Asian J Surg. 2019;42(1):19–31. https://doi.org/10.1016/j.asjsur.2018.05.008.

    Article  PubMed  Google Scholar 

  34. Miller HP, Hakim A, Kellish A, et al. Cost-benefit analysis of robotic vs. laparoscopic hepatectomy: a propensity-matched retrospective cohort study of American College of Surgeons National Surgical Quality Improvement Program Database. Am Surg. 2021:31348211011124. https://doi.org/10.1177/00031348211011124.

  35. Efanov M, Alikhanov R, Tsvirkun V, et al. Comparative analysis of learning curve in complex robot-assisted and laparoscopic liver resection. HPB. 2017;19(9):818–24. https://doi.org/10.1016/j.hpb.2017.05.003.

    Article  PubMed  Google Scholar 

  36. Troisi RI, Giglio MC. Pure laparoscopic explant hepatectomy: the penultimate step toward a minimally invasive robotic-assisted liver transplantation? Liver Transplant. 2021;27(10):1378–9. https://doi.org/10.1002/lt.26184.

    Article  Google Scholar 

  37. Troisi RI, Elsheikh Y, Alnemary Y, et al. Safety and feasibility report of robotic-assisted left lateral sectionectomy for pediatric living donor liver transplantation. Transplantation. 2021;105:1044–51. https://doi.org/10.1097/tp.0000000000003332.

    Article  PubMed  Google Scholar 

  38. Cassese G, Troisi RI. Indocyanine green applications in hepato-biliary surgery. Minerva Surg. 2021;76(3):199–201. https://doi.org/10.23736/S2724-5691.21.08809-2.

  39. Tang R, Ma LF, Rong ZX, et al. Augmented reality technology for preoperative planning and intraoperative navigation during hepatobiliary surgery: a review of current methods. Hepatobiliary Pancreat Dis Int. 2018;17(2):101–12. https://doi.org/10.1016/j.hbpd.2018.02.002.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Transplantation Service, Federico II University Hospital, Naples, Italy

    Mariano Cesare Giglio, Gianluca Cassese & Roberto Ivan Troisi

Authors
  1. Mariano Cesare Giglio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gianluca Cassese
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roberto Ivan Troisi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roberto Ivan Troisi .

Editor information

Editors and Affiliations

  1. Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Paolo Aseni

  2. Divisione di Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo, Pavia, Pavia, Italy

    Antonino Massimiliano Grande

  3. Div. of Emerg. Surg., Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland

    Ari Leppäniemi

  4. Department of Pathophysiology and Transplantation, General Surgery and Trauma Team, University of Milano, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Osvaldo Chiara

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Giglio, M.C., Cassese, G., Troisi, R.I. (2023). Safety of Minimally Invasive Laparoscopic Approach in Major Liver Surgery. In: Aseni, P., Grande, A.M., Leppäniemi, A., Chiara, O. (eds) The High-risk Surgical Patient. Springer, Cham. https://doi.org/10.1007/978-3-031-17273-1_43

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-17273-1_43

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-17272-4

  • Online ISBN: 978-3-031-17273-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation