gms | German Medical Science

Background: In this video, we present indications and technical aspects of the laparoscopic approach for liver surgery. In particular, the impact of underlying disease and intrahepatic tumor location on decision making regarding the surgical strategy are described.

Materials and methods: Resection and/or ablation of intrahepatic lesions was performed in patients requiring liver surgery and amenable to a laparoscopic approach, according to tumor size, number, location and underlying disease. We here present positioning of the patient with regard to the tumor location as well as placement of trocars and the application of a banding for an eventual pringle maneuver. For resection, various dissection or stapling devices were applied depending on tumor extent. Local ablation of liver lesions was performed using microwave heat and image-guided navigation where feasible. Perioperative complications and lengths of hospital stay were assessed in a retrospective manner.

Results: In total, 99 patients were treated laparoscopically from 2012 to 2015. Twenty patients underwent laparoscopic ablation, 70 patients had atypical or segmental resection. Combined interventions (resection and ablation) were performed in 9 patients. Postoperative complications occurred in 6 patients (6%), 4 were above grade III according to the Clavien-Dindo classification. Median length of hospital stay was 4 (1-22) days.

Conclusion: This teaching video demonstrates the theoretical and practical key points for laparoscopic local resection and ablation of liver lesions, with a special emphasis on preoperative planning and intraoperative techniques. When performed in a standardized set-up and technique, the laparoscopic approach represents a safe and feasible treatment option for patients amenable to liver surgery.