Indian Association of Surgical Gastroenterology, XXIV National Conference of Indian Association of Surgical Gastroenterology

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Laparoscopic major Hepatectomies: A decade long experience from India
Sandeep C Sabnis, Senthilnathan Palanisamy, Nikunj D Patel, Nalankilli Palanisamy, Anand Vijay, Palanivelu Chinnasamy

Last modified: 2014-09-17

Abstract


INTRODUCTION:

With technological innovations especially newer parenchymal transection devices, improved understanding of hepatic anatomy facilitated by better imaging and reconstructions along with experiences gained from developments in liver transplantation, laparoscopic liver surgery is gaining momentum resulting in more than 3000 reported cases worldwide. In India, we are still in infancy with few centers performing these complex procedures in selected patients, mostly involving segments/sections.

Aim of this article is to share our technique and experience of total laparoscopic major hepatectomies over 13 years.

MATERIAL & METHODS:

It is a retrospective analysis of prospectively maintained database of 56 patients, who underwent laparoscopic major hepatectomy for various lesions of liver during 2001 to 2013.

RESULTS:

Of 56 patients operated, 42 had malignant disease (HCC 38, colorectal metastasis 04) and 14 had benign lesions with mean size of 6.0+/-2.88 cm. Thirty four patients underwent right hepatectomy and 22 left with mean age of 54.86+/-15.35 years. Mean operating time was 227.4+/-51.88 minutes with mean blood loss 265.5+/-143.4 ml and transfusion needed in 10.71%. Pringle’s maneuver was required in 19.64% with mean occlusion time of 54 minutes. Liver specific complications observed in 12.5% and overall complications in 14.28%. Mean resection margin length in malignant lesions was 2.19+/-0.97cm, with <1 cm margin noted in 4.76%. Median hospital stay was 8 (6-29) days with readmission rate of 3.57% and 30 days mortality of 1.78%.

CONCLUSION:

Laparoscopic major liver resection is a formidable task, demanding advanced skills and anatomical knowledge. Our experience reaffirms it’s feasibility, safety and outcome.


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