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Laparoscopic parenchymal-sparing liver resection of lesions in the central segments: feasible, safe, and effective

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Abstract

Introduction

Here we report the first systematic evaluation of laparoscopic parenchymal-sparing segmentectomies for the resection of lesions in the central liver segments and the first series of laparoscopic mesohepatectomies.

Patients and Methods

From 1995 to 2012, 482 laparoscopic hepatectomies were performed. Thirty-two patients underwent isolated resection of IVa and VIII, bisegmentectomies of IVa/IVb and V/VIII, or mesohepatectomy. Sixteen isolated resections of IVb or V were excluded. Data was extracted from a retrolective database and chart review. Complications were classified (Clavien–Dindo) by three independent surgeons. Seventeen patients had colorectal liver metastasis, four had neuroendocrine tumors, five had hepatocellular carcinoma, two had GIST, and one each had esophageal cancer, breast cancer, and melanoma. Fifteen patients underwent anatomic- and 17 non-anatomic wedge resection. Average blood loss was 403 cc (SD 475), and overall operative time was 183 (SD 106) for hepatectomy and 253 min (SD 94) for mesohepatectomies. Major complications were mainly attributable to synchronous procedures. Mortality, transfusion, and morbidity rates were 0, 12, and 37 %, respectively.

Conclusion

Parenchymal-sparing laparoscopic central liver resections and mesohepatectomies are feasible, safe, and effective if specific technical details we have learned over time are considered. Concomitant procedures should be an exception. This approach exhibits an alternative to open surgery while avoiding unnecessary sacrifice of functional parenchyma.

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Disclosures

Drs. Claudius Conrad, Satoshi Ogiso, Yosuke Inoue, Nairuthya Shivathirthan, Brice Gayet reports no financial interests or potential conflicts of interest.

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Authors and Affiliations

  1. Department of Digestive Pathology, Institute Mutulatiste Montsouris, Paris Descartes University, Paris, France

    Claudius Conrad, Satoshi Ogiso, Nairuthya Shivathirthan & Brice Gayet

  2. Unit 1484, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA

    Claudius Conrad

  3. The Cancer Institute Hospital, University of Tokyo, Tokyo, Japan

    Yosuke Inoue

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  1. Claudius Conrad
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  2. Satoshi Ogiso
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  3. Yosuke Inoue
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  4. Nairuthya Shivathirthan
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  5. Brice Gayet
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Correspondence to Claudius Conrad.

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Conrad, C., Ogiso, S., Inoue, Y. et al. Laparoscopic parenchymal-sparing liver resection of lesions in the central segments: feasible, safe, and effective. Surg Endosc 29, 2410–2417 (2015). https://doi.org/10.1007/s00464-014-3924-9

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