Skip to main content
SpringerLink
Account

Laparoscopic liver resection and the learning curve: a 14-year, single-center experience

Download PDF

You have full access to this open access article

Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopic liver resection has not been widely used because of intraoperative bleeding. This problem should be solved with instruments and techniques that require a short learning curve.

Materials and methods

The aim of this work was to present the technique used in our center to perform laparoscopic liver resection using the ‘curettage and aspiration’ technique with laparoscopic Peng’s multifunctional operational dissectors and regional occlusion of inflow and outflow. We retrospectively analyzed patients who underwent a laparoscopic liver resection from August 1998 to August 2012, and collected the conversion rate, operating time, blood loss, hospitalization, bile leakage rate, bleeding rate, and other complications on a yearly basis and in total. We used SPSS software to analyze whether there was a significant difference, and summarized the learning curve of laparoscopic liver resection with various procedures.

Results

We performed 365 cases of laparoscopic liver resection, including left hemihepatectomy, left lateral lobectomy, segmental hepatectomy, non-anatomic liver resection, right hemihepatectomy, and caudate lobectomy. The diseases included liver cancer, hepatolithiasis, liver hemangioma, focal nodular hyperplasia, liver abscess, and metastatic hepatic carcinoma. In total, 63 cases (17.20 %) were converted to open surgery because of severe adhesions, bleeding, or anatomical limitation. Mean blood loss was 370.6 ± 404.0 ml; mean operating time was 150.8 ± 73.0 min; and mean postoperation hospitalization was 9.2 ± 5.3 days. There were four cases (1.32 %) with the complication of bile leakage and two cases of hemorrhage (0.66 %). No intraoperative or postoperative deaths occurred. After finishing 15–30, 43, 35, and 28 cases of laparoscopic left hemihepatectomy, left lateral hepatectomy, non-anatomic liver resection, and segmentectomy, respectively, the average operating time, blood loss, and hospitalization were almost the same as the overall mean results.

Conclusion

The technique used in our center is a safe, fast, and effective approach to laparoscopic liver resection. Our 14 years of experience demonstrates that this technique can prevent postoperative bleeding and bile leakage. A surgeon can master the skill of laparoscopic left hemihepatectomy, left lateral hepatectomy, non-anatomic liver resection, and segmentectomy after ∼15–30, 43, 35, and 28 case procedures, respectively.

Article PDF

Similar content being viewed by others

Use our pre-submission checklist

Avoid common mistakes on your manuscript.

References

  1. Robles R, Marín C, Abellán B, López-Conesa A, Ramírez P, Parrilla P (2006) Right hepatectomy and left hepatectomy performed via hand-assisted laparoscopic surgery. Description of an original technique (in Spanish). Cir Esp 80:326–330

    Article  PubMed  Google Scholar 

  2. Liu R, Huang ZQ, Zhou NX, Huang XQ, Wang YH, Jiang K, Xiang X (2004) Operational line of laparoscopic liver resections. Zhonghua Yi Xue Za Zhi 84:219–221

    PubMed  Google Scholar 

  3. Machado MA, Surjan RC, Makdissi FF (2011) Intrahepatic glissonian approach for pure laparoscopic right hemihepatectomy. Surg Endosc 25:3930–3933

    Article  CAS  PubMed  Google Scholar 

  4. Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection: 2,804 patients. Ann Surg 250: 831–841

    Article  PubMed  Google Scholar 

  5. Cai XJ, Yu H, Liang X, Wang YF, Zheng XY, Huang DY, Peng SY (2006) Laparoscopic hepatectomy by curettage and aspiration: experiences of 62 cases. Surg Endosc 20:1531–1535

    Article  CAS  PubMed  Google Scholar 

  6. Peng SY (1994) Multifunctional operational dissectors. China Patent CN1080512

  7. Peng SY, Su Y, Cai XJ (2007) Operational dissectors. China Patent CN3671884

  8. Cai XJ, Gu XJ, Wang YF, Yu H, Liang X (2007) Experience in laparoscopic cholecystectomy by exposing common hepatic duct using blunt dissection to prevent bile duct injury. Zhonghua Yi Xue Za Zhi 87:1425–1426

    PubMed  Google Scholar 

  9. Peng SY, Li JT, Mou YP, Liu YB, Wu YL, Fang HQ, Cao LP, Chen L, Cai XJ, Peng CH (2003) Different approaches to caudate lobectomy with “curettage and aspiration” technique using a special instrument PMOD: a report of 76 cases. World J Gastroenterol 9:2169–2173

    PubMed  Google Scholar 

  10. Cai XJ, Wang YF, Liang YL, Yu H, Liang X (2009) Laparoscopic left hemihepatectomy: a safety and feasibility study of 19 cases. Surg Endosc 23:2556–2562

    Article  PubMed  Google Scholar 

Download references

Disclosures

Xiujun Cai, Zheyong Li, Yale Zhang, Hong Yu, Xiao Liang, Renan Jin, and Feng Luo have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Key Laboratory of Laparoscopic Technique of Zhejiang Province, Department of General Surgery, Sir Run Run Shaw Hospital, Institute of Minimally Invasive Surgery of Zhejiang University, Zhejiang University, No. 3, Qingchun Road East, Hangzhou, 310016, China

    Xiujun Cai

  2. College of Medicine, Zhejiang University, Hangzhou, China

    Zheyong Li, Yale Zhang & Renan Jin

  3. Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China

    Hong Yu & Xiao Liang

  4. Department of Anesthesiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China

    Feng Luo

Authors
  1. Xiujun Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zheyong Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yale Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hong Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiao Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Renan Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Feng Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xiujun Cai.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (WMV 286650 kb)

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

Reprints and permissions

About this article

Cite this article

Cai, X., Li, Z., Zhang, Y. et al. Laparoscopic liver resection and the learning curve: a 14-year, single-center experience. Surg Endosc 28, 1334–1341 (2014). https://doi.org/10.1007/s00464-013-3333-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-013-3333-5

Keywords

Search

Navigation