gms | German Medical Science

Background: In addition to the well-known advantages of minimally-invasive surgery, the laparoscopic approach for resection or local ablation of liver lesions allows tissue-sparing and repeated treatment strategies. However, acquiring experience in surgical techniques and maintenance of safeness remain challenging. In order to share our experience, we report safety results and short-term responses in the first series of laparoscopic liver surgeries performed in our institution.

Materials and methods: All patients that underwent laparoscopic liver surgery from 2012 to 2015 were analyzed retrospectively. Surgical interventions included local or segmental resection, ablation using microwave energy or combined interventions of both ablation and resection in treatment of multiple lesions. Minimal resection margins were extracted from histological records. In patients with malignant lesions (hepatocellular carcinoma HCC and colorectal liver metastases CRLM) and where image data was available, radiological response was extracted at 12 month after surgery.

Results: Ninety-nine patients with 171 hepatic lesions underwent laparoscopic liver surgery between January 2012 and September 2015. Out of these patients, 71 presented with malignant hepatic disease (43 HCC, 28 CRLM), the rest being benign liver lesions. Treatment included 90 lesions located in the left liver and 81 lesions in the right liver. Local resections (including segmentectomy) were performed in 63 patients, resection of 2 or more combined segments in 16 cases. Combined resections and ablations were performed in 9 patients. Median operative time 2.15h (range 0.75-5.15h). Complications: Type II and below in 3, Type IV in 1, Type V in 2 patients. Median length of stay 4 days (range 1-22). At 12 months, 12/21 (57%) of HCC patients and 3/5 (60%) of CRLM patients remained without local or distant intrahepatic tumor.

Conclusion: Our experience with laparoscopic liver surgery in the last four years revealed reasonable operation times, short length of hospital stay and very low complication rates. Laparoscopic resection and ablation of liver lesions was safe with acceptable radiological response rates at short-term follow-up.