• Humans
• Cost-Benefit Analysis
• Hepatectomy/economics
• Hepatectomy/methods
• Hepatectomy/adverse effects
• Laparoscopy/economics
• Laparoscopy/methods
• Laparoscopy/adverse effects
• Length of Stay/economics
• Length of Stay/statistics & numerical data
• Network Meta-Analysis
• Postoperative Complications/economics
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Robotic Surgical Procedures/economics
• Robotic Surgical Procedures/adverse effects

Laparoscopic liver resection (LLR) is a highly demanding procedure with great variability. Previously published randomized trials have proven oncological safety of laparoscopic liver resection (LLR) as compared to open surgery. However, these were started after the learning curve (LC) was established. This leaves the question of whether the LC of LLR in the early laparoscopic era has affected the survival of patients with colorectal liver metastasis (CRLM).

All consecutive LLRs performed by a single surgeon between 2000 and 2019 were retrospectively analysed. A risk-adjusted cumulative sum (RA-CUSUM) chart for conversion rate and the log regression analysis of the blood loss identified two phases in the LC. This was then applied to patients with CRLM, and the two subgroups were compared for recurrence-free (RFS) and overall survival (OS). The analysis was repeated with propensity score-matched (PSM) groups

A total of 286 patients were included in the LC analysis, which identified two distinct phases, the early (EP; 68 patients) and the late (LP; 218 patients) phases. The LC was applied to 192 patients with colorectal liver metastasis (EPc, 45 patients; LPc, 147 patients). For patients with CRLM, R0 resection was achieved in 93 per cent: 100 per cent in the EPc group and 90 per cent in the LPc group (P = 0.026). Median OS and RFS were 60 and 16 months, respectively. The 5-year OS and RFS were 51 per cent and 32.7 per cent, respectively. OS (hazard ratio (h.r.) 0.78, 95 per cent confidence interval (c.i.) 0.51 to 1.2; P = 0.286) and RFS (h.r. 0.94, 95 per cent c.i. 0.64 to 1.37; P = 0.760) were not compromised by the learning curve. The results were replicated after PSM.

In our experience, the development of a laparoscopic liver resection programme can be achieved without adverse effects on the long-term survival of patients with CRLM.

• Colorectal Neoplasms/pathology
• Humans
• Laparoscopy/methods
• Learning Curve
• Liver/pathology
• Retrospective Studies

• laparoscopic surgery
• liver transplant
• living‐donor hepatectomy
• robotic surgery

• liver resection
• necessity
• rationality
• vascular stapler
• vessel transection

Background. Laparoscopic liver resection (LLR) has emerged as a considerable alternative to conventional liver surgery. However, the increasing complexity of liver resection raises the incidence of postoperative complications. The aim of this study was to identify risk factors for postoperative morbidity in a monocentric cohort of patients undergoing LLR. Methods. All consecutive patients who underwent LLR between 2015 and 2019 at our institution were analyzed for associations between complications with demographics and clinical and operative characteristics by multivariable logistic regression analyses. Results. Our cohort comprised 156 patients who underwent LLR with a mean age of 60.0 ± 14.4 years. General complications and major perioperative morbidity were observed in 19.9% and 9.6% of the patients, respectively. Multivariable analysis identified age>65 years (HR = 2.56; P = .028) and operation time>180 minutes (HR = 4.44; P = .001) as significant predictors of general complications (Clavien ≥1), while albumin<4.3 g/dl (HR = 3.66; P = .033) and also operative time (HR = 23.72; P = .003) were identified as predictors of major postoperative morbidity (Clavien ≥3). Conclusion. Surgical morbidity is based on patient- (age and preoperative albumin) and procedure-related (operative time) characteristics. Careful patient selection is key to improve postoperative outcomes after LLR.

• complications
• laparoscopic surgery
• liver resection
• morbidity
• postoperative outcome

The application of laparoscopic liver resection (LLR) has expanded rapidly in recent decades. Although multiple authors have reported LLR shows improved safety and efficacy in treating hepatocellular carcinoma (HCC) compared with open liver resection (OLR), laparoscopic (LMLR) and open (OMLR) major liver resections for HCC treatment remain inadequately evaluated. This work aimed to test the hypothesis that LMLR is safer and more effective than OMLR for HCC.

Comparative cohort and registry studies on LMLR and OMLR, searched in PubMed, the Science Citation Index, EMBASE, and the Cochrane Library, and published before March 31, 2018, were collected systematically and meta-analyzed. Fixed- and random-effects models were employed for generating pooled estimates. Heterogeneity was assessed by the Q-statistic.

Nine studies (1173 patients) were included. Although the pooled data showed operation time was markedly increased for LMLR in comparison with OMLR (weighted mean difference [WMD] 74.1, 95% CI 35.1 to 113.1, P = 0.0002), blood loss was reduced (WMD = − 107.4, 95% CI − 179.0 to − 35.7, P = 0.003), postoperative morbidity was lower (odds ratio [OR] 0.47, 95% CI 0.35 to 0.63, P <  0.0001), and hospital stay was shorter (WMD = − 3.27, 95% CI − 4.72 to − 1.81, P <  0.0001) in the LMLR group. Although 1-year disease-free survival (DFS) was increased in patients administered LMLR (OR = 1.55, 95% CI 1.04 to 2.31, P = 0.03), other 1-, 3-, and 5-year survival outcomes (overall survival [OS] and/or DFS) were comparable in both groups.

Compared with OMLR, LMLR has short-term clinical advantages, including reduced blood loss, lower postsurgical morbidity, and shorter hospital stay in HCC, despite its longer operative time. Long-term oncological outcomes were comparable in both groups.

• Hepatocellular carcinoma
• Laparoscopic surgery
• Major liver resection
• Meta-analysis

• Consensus
• Hepatectomy
• Laparoscopic
• Liver resection
• Outcomes

• Approach
• Concept
• Hepatocellular carcinoma
• History
• Laparoscopic liver resection
• Liver cancer
• Liver cirrhosis
• Posture
• Repeat resection
• Simulation
• Technique

• Carcinoma, Hepatocellular/surgery
• Hepatectomy/methods
• Hepatectomy/trends
• Humans
• Laparoscopy/methods
• Laparoscopy/trends
• Liver/surgery
• Liver Cirrhosis/surgery
• Liver Failure/prevention & control
• Liver Neoplasms/surgery
• Postoperative Complications/prevention & control
• Reoperation
• Treatment Outcome

Laparoscopic liver resection (LLR) has evolved and broadened in scope. While open liver resections are currently being performed safely in our hospital, LLRs are being implemented in fewer cases. The aim of this study was to review our initial experience in LLR to assess early outcomes of the procedure.

A retrospective chart review was conducted for 37 patients who underwent laparoscopic liver resections for various indications between January 2014 and July 2017 by a single surgeon who had performed 161 open liver resections and 50 live donor hepatectomies during the same period.

Of 37 laparoscopic liver resections performed, male to female ratio was 23 to 4. Their mean age was 61.4 years. There were 13 cases of wedge resections, 7 cases of left lateral sectionectomy, 9 cases of left hepatectomy, and 8 cases of right hepatectomy. Pathology included hepatocellular carcinoma (n=20), cholangiocarcinoma (n=3), intrahepatic duct stones (n=6), metastatic liver carcinoma (n=6), primary neuroendocrine tumor of liver (n=1), and huge hemangioma (n=1). The mean operation time was 174.7 minutes (range, 40–410 minutes). Mean blood loss was 200.5 ml (range, 10–2200 ml). There were no open-conversion cases. There were no intraoperative or postoperative complications except that a case of severe portal vein stenosis in the laparoscopic right hepatectomy occurred postoperatively. The patient underwent reoperation (portal vein resection and anastomosis, stenting). The mean hospital stay was 8.7 days (range, 2–44 days).

Even though our experience in laparoscopic liver resection is still developing, our results are comparable to those of other studies. Therefore, an experienced surgeon in performing open liver resection should be able to perform the laparoscopic liver resection safely.

• Laparoscopic liver resection
• Laparoscopic major hepatectomy
• Open liver resection

• Complex cases
• Laparoscopic hepatectomy
• Left lateral sectionectomy
• Robotic hepatectomy

Quadratus lumborum (QL) block is increasingly being used as a new abdominal nerve block technique. In some studies of mid and lower abdominal and hip analgesia, continuous QL block achieved favorable outcomes as an alternative to continuous intravenous analgesia with opioids. However, the use of continuous QL block for upper abdominal pain is less well characterized. This study aimed to investigate the effects of continuous anterior QL block (CQLB) on postoperative pain and recovery in patients undergoing open liver resection.

Sixty-three patients underwent elective open liver resection were randomly divided into continuous anterior QL block (CQLB, n = 32) group and patient-controlled intravenous analgesia (PCIA, n = 31) group. Patients in CQLB group underwent ultrasound-guided anterior QL block at the second lumbar vertebral transverse processes before general anesthesia, followed by postoperative CQLB analgesia. Patients in PCIA group underwent continuous intravenous analgesia postoperatively. Postoperative numerical rating scale (NRS) pain scores upon coughing and at rest, self-administered analgesic counts, rate of rescue analgesic use, time to first out-of-bed activity and anal flatus after surgery, and incidences of analgesic-related adverse effects were recorded.

Postoperative NRS pain scores on coughing in CQLB group at different time points and NRS pain score at rest 48 h after surgery were significantly lower than those in PCIA group (P < 0.05). Time to first out-of-bed activity and anal flatus after surgery in CQLB group were significantly earlier than those in PCIA group (P < 0.05). No significant differences of postoperative self-administered analgesic counts, rate of postoperative rescue analgesic usage, or incidences of analgesic-related adverse effects were found between the two groups (P > 0.05).

Ultrasound-guided anterior QL block significantly alleviated the pain during coughing after surgery, shortened the time to first out-of-bed activity and anal flatus, promoting postoperative recovery of the patients undergoing open liver resection.

This study has been registered in April 1, 2018 on Chinese Clinical Trail Registry, the registration number is ChiCTR1800015454.

• Continuous quadratus lumborum block
• Liver resection
• Postoperative analgesia
• Ultrasound guidance

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.

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.

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%).

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.

• Hepatectomy
• Laparoscopy
• Learning curve
• Minimally invasive surgical procedures

• evidence-based medicine/surgery
• hepatobiliary
• interventional endoscopy

• Approach
• Concept
• Hepatectomy
• History
• Laparoscopic surgery
• Liver cancer
• Posture
• Simulation
• Technique
• Technology

• Feasibility Studies
• Gastroenterology/history
• Hepatectomy/methods
• History, 20th Century
• History, 21st Century
• Humans
• Incidence
• Laparoscopy/methods
• Length of Stay
• Liver/surgery
• Liver Failure/surgery
• Liver Neoplasms/surgery
• Treatment Outcome

• laparoscopic hepatectomy
• laparoscopic liver
• major
• robotic hepatectomy
• robotic liver

• laparoscopic liver resection
• major hepatectomy

• Adult
• Aged
• Female
• Follow-Up Studies
• Hepatectomy/methods
• Humans
• Incidence
• Intraoperative Complications/epidemiology
• Laparoscopy/methods
• Liver Diseases/surgery
• Male
• Middle Aged
• Postoperative Complications/epidemiology
• Prognosis
• Republic of Korea/epidemiology
• Retrospective Studies
• Survival Rate/trends
• Young Adult

• Laparoscopic liver resection
• Minimal invasive liver surgery
• Single-port laparoscopic liver resection
• Single-port laparoscopic surgery

• Hepatectomy
• Laparoscopic cholecystectomy
• Minimally invasive surgical procedures
• Robotic surgical procedures

• Colorectal liver metastases
• hepatocellular carcinoma (HCC)
• laparoscopic liver resection (LLR)
• learning curve
• liver cancer

• Hepatocellular carcinoma
• Laparoscopic liver surgery
• Liver resection
• Major hepatectomy
• Major liver resection

• Adult
• Aged
• Blood Transfusion
• Female
• Hepatectomy/adverse effects
• Hepatectomy/methods
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Length of Stay
• Liver Diseases/mortality
• Liver Diseases/pathology
• Liver Diseases/surgery
• Male
• Middle Aged
• Operative Time
• Retrospective Studies
• Treatment Outcome

• Bile Duct Neoplasms/surgery
• Bile Ducts, Intrahepatic
• Carcinoma, Hepatocellular/surgery
• Cholangiocarcinoma/surgery
• Hepatectomy/methods
• Humans
• Laparoscopy
• Liver Diseases/surgery
• Liver Neoplasms/secondary
• Liver Neoplasms/surgery
• Treatment Outcome

• Biliary Fistula/etiology
• Biliary Fistula/prevention & control
• Biliary Fistula/therapy
• Combined Modality Therapy
• Hepatectomy/methods
• Humans
• Liver Diseases/surgery
• Minimally Invasive Surgical Procedures/methods
• Postoperative Complications/etiology
• Postoperative Complications/prevention & control
• Postoperative Complications/therapy
• Postoperative Hemorrhage/etiology
• Postoperative Hemorrhage/prevention & control
• Postoperative Hemorrhage/therapy
• Reoperation

• Intrahepatic duct stone
• Laparoscopic left hemihepatectomy
• Open left hemihepatectomy

• French position statement
• Laparoscopic liver resection
• Perspectives
• Update

• Energy device
• Laparoscopy
• Liver surgery
• Stapling device
• Technique
• Transection

The use of minimally invasive surgery has become widely accepted in many gastrointestinal fields, even in patients with malignancy. However, performing laparoscopic resection for the treatment of hilar cholangiocarcinoma is still not universally accepted as an alternative approach to open surgery, and only a limited number of such procedures have been reported due to the difficulty of performing oncologic resection and the lack of consensus regarding the adequacy of this approach. Laparoscopy was initially limited to staging, biopsy and palliation. Recent technological developments and improvements in endoscopic procedures have greatly expanded the applications of laparoscopic liver resection and lymphadenectomy, and some reports have described the use of laparoscopic or robot-assisted laparoscopic resection for hilar cholangiocarcinoma as being feasible and safe in highly selected cases, with the ability to obtain an adequate surgical margin. However, the benefits of major laparoscopic surgery have yet to be conclusively proven, and carefully selecting patients is essential for successfully performing this procedure.

• Hilar cholangiocarcinoma
• Laparoscopy
• Minimally invasive surgery

• Bile Duct Neoplasms/pathology
• Bile Duct Neoplasms/surgery
• Bile Ducts, Intrahepatic/pathology
• Bile Ducts, Intrahepatic/surgery
• Cholangiocarcinoma/pathology
• Cholangiocarcinoma/surgery
• Hepatectomy/adverse effects
• Hepatectomy/methods
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Lymph Node Excision/adverse effects
• Lymph Node Excision/methods
• Palliative Care
• Patient Selection
• Risk Assessment
• Risk Factors
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/methods
• Treatment Outcome

Laparoscopic liver surgery is now an established practice in many institutions. It is a safe and feasible approach in experienced hands. Single incision laparoscopic surgery (SILS) has been performed for cholecystectomies, nephrectomies, splenectomies and obesity surgery. However, the use of SILS in liver surgery has been rarely reported. We report our initial experience in seven patients on single incision laparoscopic hepatectomy (SILH).

From October 2010 to September 2012, seven patients underwent single-incision laparoscopic liver surgery. The abdomen was approached through a 25 mm periumbilical incision. No supplemental ports were required. The liver was transected using a combination of LigaSure™ (Covidien-Valleylab. Boulder. USA), Harmonic Scalpel and Ligaclips (Ethicon Endo-Surgery, Inc.).

Liver resection was successfully completed for the seven patients. The procedures consisted of two partial resections of segment three, two partial resections of segment five and three partial resections of segment six. The mean operative time was 98.3 min (range: 60-150 min) and the mean estimated blood loss was 57 ml (range: 25-150 ml). The postoperative courses were uneventful and the mean hospital stay was 5.1 days (range: 1-13 days). Pathology identified three benign and four malignant liver tumours with clear margins.

SILH is a technically feasible and safe approach for wedge resections of the liver without oncological compromise and with favourable cosmetic results. This surgical technique requires relatively advanced laparoscopic skills. Further studies are needed to determine the potential advantages of this technique, apart from the better cosmetic result, compared to the conventional laparoscopic approach.

• Hepatectomy
• laparoscopic liver resection
• single incision laparoscopic hepatectomy (SILH)
• single incision laparoscopic surgery (SILS)

• Hepatectomy
• Laparoscopy
• Liver resection
• Segmentectomy
• Surgery

Hepatocellular carcinoma (HCC) is a common cancer, especially in the Association of Southeast Asian Nations (ASEAN) region, where the prevalence of hepatitis virus infection is high. Liver resection is a potentially curative and popular therapy for HCC. Laparoscopic surgery using minimally invasive techniques potentially brings benefits to patients who need liver resection for HCC. This study aimed to evaluate the effectiveness, safety, and benefits of laparoscopic liver resection for HCC with long-term follow-up evaluation.

This cohort study with 5-year results of total laparoscopic hepatectomy for HCC was conducted in one center. Patients with HCC were selected for laparoscopic liver resection by the same team. The operation also was performed by one team of surgeons. The follow-up protocol was similar to that for open surgery. The patients were scheduled to return for examination every 2 months after the operation. The data for the patients were collected and analyzed using SPSS software.

From January 2008 to December 2012, 173 enrolled patients with HCC underwent laparoscopic liver resection. The male-to-female ratio was 3:1. The mean age of the patients was 56 years (range 16–83 years). The follow-up period for 130 patients was 21.6 ± 16.0 months (range 0–60 months). The mean tumor size was 3.73 cm (range 2–10 cm). The stages of HCC according to the Barcelona Clinic Liver Cancer (BCLC) categorization were as follows: 0 (6 %), A1 (59.5 %), A2 (6.9 %), A4 (2.9 %), and B (27.2 %). Four patients required conversion to other techniques (2.3 %) because of the potential for major bleeding and tumor perforation. The types of resection were resection of one segment (segments 2, 3, 4, 5, 6, 7, and 8; 43.8 %), resection of two segments (posterior sector, anterior sector, segments 5 and 6, and left lateral sector; 47.9 %), resection of three segments (left and central liver; 4.7 %), and four segments (right liver; 3.6 %). The mean operation time was 112 ± 56 min (range 30–345 min), and the median blood loss was 100 ml (range 20–1,200 ml). The mean hospital stay was 6.5 ± 2.0 days (range, 3–19 days). No perioperative mortality occurred. The overall survival rates were 94.2 % at 1 year, 87 % at 2 years, 72.9 % at 3 years, 72.9 % at 4 years, and 72.9 % at 5 years. The mean overall survival time was 49.7 ± 2.1 months (range 45.5–53.9 months). The disease-free survival rates were 79.1 % at 1 year, 60 % at 2 years, 57 % at 3 years, 52 % at 4 years, and 26.3 % at 5 years. The mean disease-free survival time was 38.9 ± 2.6 months (range 33.9–44.0 months).

Laparoscopic liver resection for HCC is feasible, safe, and effective, with good oncologic results. Major and anatomic hepatectomy are possible with improved skill and experience. Laparoscopic liver resection is a promising treatment option with minimally invasive benefits for HCC patients.

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Equipment Design
• Female
• Hepatectomy/methods
• Humans
• Incidence
• Japan/epidemiology
• Laparoscopy/methods
• Length of Stay
• Liver Cirrhosis/mortality
• Liver Cirrhosis/surgery
• Male
• Middle Aged
• Postoperative Complications/epidemiology
• Surgical Staplers
• Survival Rate/trends
• Suture Techniques/instrumentation
• Treatment Outcome
• Young Adult