Laparoscopic liver resection: indications, limitations, and economic aspects

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Abstract

Background

Minimally invasive techniques have increasingly found their way into liver surgery in recent years. A multitude of mostly retrospective analyses suggests several advantages of laparoscopic over open liver surgery. Due to the speed and variety of simultaneous technical and strategic developments, it is difficult to maintain an overview of the current status and perspectives in laparoscopic liver surgery.

Purpose

This review highlights up-to-date aspects in laparoscopic liver surgery. We discuss established indications with regard to their development over time as well as continuing limitations of applied techniques. We give an assessment based on the current literature and according to our own center experiences, not least with regard to a highly topical cost discussion.

Conclusions

While in the beginning mainly benign tumors were laparoscopically operated on, liver metastasis and hepatocellular carcinoma are now among the most frequent indications. Technical limitations remain and should be evaluated with the overall aim not to endanger quality standards in open surgery. Financial aspects cannot be neglected with the necessity of cost-covering reimbursement.

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Most cited references 73

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The Southampton Consensus Guidelines for Laparoscopic Liver Surgery

Mohammad Abu Hilal, Luca Antonio Aldrighetti, Ibrahim Dagher … (2018)

The European Guidelines Meeting on Laparoscopic Liver Surgery was held in Southampton on February 10 and 11, 2017 with the aim of presenting and validating clinical practice guidelines for laparoscopic liver surgery.

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Laparoscopic liver resections: a feasibility study in 30 patients.

F Stephan, R Hammoud, D Cherqui … (2000)

To assess the feasibility and safety of laparoscopic liver resections. The use of the laparoscopic approach for liver resections has remained limited for technical reasons. Progress in laparoscopic procedures and the development of dedicated technology have made it possible to consider laparoscopic resection in selected patients. A prospective study of laparoscopic liver resections was undertaken in patients with preoperative diagnoses including benign lesion, hepatocellular carcinoma with compensated cirrhosis, and metastasis of noncolorectal origin. Hepatic involvement had to be limited and located in the left or peripheral right segments (segments 2-6), and the tumor had to be 5 cm or smaller. Surgical technique included CO2 pneumoperitoneum and liver transection with a harmonic scalpel, with or without portal triad clamping or hepatic vein control. Portal pedicles and large hepatic veins were stapled. Resected specimens were placed in a bag and removed through a separate incision, without fragmentation. From May 1996 to December 1999, 30 of 159 (19%) liver resections were included. There were 18 benign lesions and 12 malignant tumors, including 8 hepatocellular carcinomas in cirrhotic patients. Mean tumor size was 4.25 cm. There were two conversions to laparotomy (6.6%). The resections included 1 left hepatectomy, 8 bisegmentectomies (2 and 3), 9 segmentectomies, and 11 atypical resections. Mean blood loss was 300 mL. Mean surgical time was 214 minutes. There were no deaths. Complications occurred in six patients (20%). Only one cirrhotic patient developed postoperative ascites. No port-site metastases were observed in patients with malignant disease. Laparoscopic resections are feasible and safe in selected patients with left-sided and right-peripheral lesions requiring limited resection. Young patients with benign disease clearly benefit from avoiding a major abdominal incision, and cirrhotic patients may have a reduced complication rate.

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What has changed after the Morioka consensus conference 2014 on laparoscopic liver resection?

Go Wakabayashi (2016)

The 2(nd) International Consensus Conference on Laparoscopic Liver Resection (ICCLLR) was held 4(th)-6(th) October, 2014, in Morioka, Japan. The level of evidence appears to be low in the field of laparoscopic liver resection (LLR) to create strong recommendations. Therefore, an independent jury-based consensus model was applied to better define the current role of LLR and to develop internationally accepted recommendations. The three-day conference was very intense with full of insightful discussions on assessment of LLR and its future directions. The jury drew the statements based on the presentations and documents prepared by the expert. LLR is theoretically superior to open liver resection (OLR) because the laparoscope allows better exposure with a magnified view, and the pneumoperitoneum pressure reduces hepatic vein bleeding from the cut surface. During the ICCLLR, we shared these theoretical advantages in LLR and the conceptual change of liver resection. After the ICCLLR, a couple of important studies have been published to prove this theoretical superiority of LLR over OLR in short-term outcomes without deteriorating long-term outcomes. Another new concept was proposed at the ICCLLR: parenchyma sparing (limited) anatomical resection. Review of the literature supports anatomical resection with parenchyma sparing strategy for LLR irrespective of hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM). Just after the ICCLLR, sensational news of clustered mortality after LLR was reported in the Japanese media and they impacted on daily practice of LLR in Japan. The most important message from the ICCLLR is to protect patients from this new surgical procedure. The ICCLLR recommended three actions for the protection of patients: (I) prospective reporting registry for transparency; (II) a difficulty scoring system to select patients; (III) creation of a formal structure of education. The online prospective registry system including items to calculate the difficulty score has been created in Japan after the ICCLLR for the safe development of LLR.

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Author and article information

Contributors

Moritz Schmelzle: moritz.schmelzle@charite.de

Journal

Journal ID (nlm-ta): Langenbecks Arch Surg

Journal ID (iso-abbrev): Langenbecks Arch Surg

Title: Langenbeck's Archives of Surgery

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 1435-2443

ISSN (Electronic): 1435-2451

Publication date (Electronic): 1 July 2020

Publication date PMC-release: 1 July 2020

Publication date (Print): 2020

Volume: 405

Issue: 6

Pages: 725-735

Affiliations

GRID grid.7468.d, ISNI 0000 0001 2248 7639, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin, Corporate Member of Freie Universität Berlin, , Humboldt-Universität zu Berlin, ; Augustenburger Platz 1, 13353 Berlin, Germany

Article

Publisher ID: 1918

DOI: 10.1007/s00423-020-01918-8

PMC ID: 7471173

PubMed ID: 32607841

SO-VID: cb418425-3859-46b3-9554-4bd418780898

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 16 June 2020

Date accepted : 23 June 2020

Funding

Funded by: Charité (3093)

Open Access :

Open Access funding provided by Projekt DEAL.

Custom metadata

ScienceOpen disciplines: Surgery

Keywords: laparoscopic liver surgery,minimally invasive liver surgery,robotic liver surgery

Data availability:

ScienceOpen disciplines: Surgery

Keywords: laparoscopic liver surgery, minimally invasive liver surgery, robotic liver surgery

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Laparoscopic liver resection: indications, limitations, and economic aspects

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Abstract

Background

Purpose

Conclusions

Related collections

Karger: Oncology

Most cited references 73

The Southampton Consensus Guidelines for Laparoscopic Liver Surgery

Laparoscopic liver resections: a feasibility study in 30 patients.

What has changed after the Morioka consensus conference 2014 on laparoscopic liver resection?

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Contributors

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Article

History

Funding

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Cited by 30

Most referenced authors 1,228