Ann Surg Treat Res.  2019 Jan;96(1):14-18. 10.4174/astr.2019.96.1.14.

Impact of technical innovation on surgical outcome of laparoscopic major liver resection: 10 years' experience at a large-volume center

• Cho W
• Kwon CH
• Choi JY
• Lee SH
• Kim JM
• Choi GS
• Joh JW
• Kim SJ
• Kim GS
• Koh KC

• KMID: 2429749
• DOI: http://doi.org/10.4174/astr.2019.96.1.14

Abstract

PURPOSE
Laparoscopic major liver resection (major LLR) remains a challenging procedure because of the technical difficulty. Several significant technical innovations have been applied in our center since 2012. They include routine application of bipolar electrocautery, initiation of temporary increase of intra-abdominal pressure during bleeding events from veins to balance the central venous pressure, and use of temporary inflow control of the Glissonean pedicle. This study evaluated the impact of these technique modifications in patients with major LLR.
METHODS
Between January 2004 and February 2015, a total of 606 patients underwent LLR at Samsung Medical Center in Seoul, Korea. Major LLR was employed in 233 cases. All major LLR procedures were anatomical resections performed with a totally laparoscopic approach. We compared surgical parameters of right hepatectomy (RH), left hepatectomy (LH), and right posterior sectionectomy (RPS) before and after 2012.
RESULTS
Open conversion rates of RH and LH and estimated blood loss in RPS significantly decreased after 2012. The postoperative complication rate of major LLR was 12.7% and was similar before and after 2012. Bile leakage was the most common complication (3.2%).
CONCLUSION
The modifications of surgical techniques resulted in good outcomes for laparoscopic major LLR. We recommend routine application of these techniques to improve outcomes, especially in patients requiring major liver resection.

Keyword

Laparoscopy; Hepatectomy; Minimally invasive surgical procedures; Learning curve

MeSH Terms

Bile
Central Venous Pressure
Electrocoagulation
Hemorrhage
Hepatectomy
Humans
Korea
Laparoscopy
Learning Curve
Liver*
Minimally Invasive Surgical Procedures
Postoperative Complications
Seoul
Veins

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