Pure laparoscopic hepatectomy as repeat surgery and repeat hepatectomy

Table 1 Upper abdominal surgical histories

Surgical history		Procedure type	Adhesion
Hepatectomy (n = 12)	S4a56a resection, lymph node dissection	Laparoscopic	Severe
	Central bisectorectomy	Open	Severe
	S3 segmentectomy	Laparoscopic	Mild
	(3rd resection) S3 segmentectomy, Pt S5-6	Laparoscopic	Severe
	Pt S5 (severe cholecystitis)	Laparoscopic	Severe
	Extended posterior sectorectomy	Open	Severe
	(3rd resection) Lateral sectorectomy, S4b-8a resection	Open	Severe
	Pt S4 and S3	Open	Severe
	Anterior sectorectomy (distal gastrectomy)	Open	Severe
	Pt S6	Open	Severe
	Pt S6	Open	Severe
	S5 segmentectomy	Open	Severe
Pancreatectomy (n = 3)	Pancreatoduodenectomy	Open	Severe
	Distal pancreatectomy	Open	Severe
	Distal pancreatectomy	Open	Severe
Colectomy (involving transverse colon) (n = 3)		Open	Severe
		Laparoscopic	Mild
		Open	Severe
Common bile duct excision (n = 1)		Open	Severe
Splenectomy (n = 1)		Laparoscopic	Mild
Total gastrectomy (n = 1)		Laparoscopic	Mild
Extended hysterectomy1 (n = 1)		Open	Severe

¹Extended hysterectomy with extensive lymph node dissection up to the upper abdomen. The degree of adhesions was classified according to Beck et al[18] (mild = grade 1-2, severe = grade 3-4). Pt: Partial resection; S: Segment.

Table 2 Characteristics of the patients with repeat hepatectomies

Sex	Age	Cause for Hx	Method for diagnosis	Hx procedures	No. of tumors	Size of tumors (mm)	Child-Pugh class	Surgery interval (mo)	Adhesion grade	Operating time (min)	Bleeding (mL)	Hospital stay (d)
M	63	IPT	CT with contrast	Pt S4a5	1	20	A	12	3	540	100	30
F	71	HCC	CT with contrast	Pt S1 (3rd Hx)	1	8	A	22	4	216	0	9
M	74	Met	CT with contrast	Pt S5, S7	4	28	A	70	4	570	840	21
F	81	HCC	CT with contrast	Pt S2-3	1	18	A	87	4	104	5	12
F	69	HCC	CT with contrast	Pt S5-6	2	30	A	28	2	168	30	9
M	65	HCC	CT with contrast	Pt S1l	1	23	A	16	4	165	50	10
F	80	HCC	CT with contrast	S3 resection	1	18	B	46	4	224	50	13
M	60	HCC	CT with contrast	Pt S4	1	35	A	16	3	286	50	14
M	77	Met	CT with contrast	Pt S4 - 8	1	20	A	15	4	245	21	9
M	72	GBCa	Pathology from 1st Hx for IPT	S4a56a resection	1	60	A	0.5	4	488	143	24
M	57	HCC	CT with contrast	Pt S7, S2	2	21	A	32	4	388	50	10
M	67	HCC	CT with contrast	PtS8	1	11	A	97	3	432	365	14

Adhesion grades according to Beck et al[18]. CT: Computed tomography; GBCa: Gall bladder carcinoma; HCC: Hepatocellular carcinoma; Hx: Hepatectomy; IPT: Inflammatory pseudo-tumor; Met: Metastasis; Pt: Partial resection; S: Segment.

Table 3 Demographic factors and background diseases of the patients

Factor	NH(n = 58)	UASH(n = 22)	RH(n = 12)
Age, yr	70 (48-82)	68 (57-81)	70 (57-81)
Sex, male/female	34/24	12/10	8/4
Chronic liver disease, yes/no	37/21	11/11	7/5
Cause for hepatectomy
Hepatocellular carcinoma	38	12	8
Metastasis	11	8	2
Others	9	2	2
Tumor
n	1 (1-4)	1 (1-6)	1 (1-4)
Size (mm)	24 (7-107)	23 (8-60)	21 (8-60)
Type of LH procedure
Major/minor	11/47	1/21	0/12
Anatomical/non-anatomical	23/35	6/16	2/10

Twelve patients in the RH group are also included in the UASH group. Values are expressed as median (range). Major resection: hemihepatectomy, central bisectionectomy, right posterior sectorectomy, right anterior sectorectomy and left median sectorectomy. Anatomical resection: the procedures in which the Glissonian pedicle was divided at the root in bifurcation and all the parenchyma related to the pedicle was resected. LH: Laparoscopic hepatectomy; NH: No history of upper abdominal surgery; RH: Repeat hepatectomy; UASH: Upper abdominal surgery history.

Table 4 Perioperative courses of the patients with laparoscopic liver resection

	NH(n = 58)	UASH(n = 22)	RH(n = 12)
Operative time (min)	301 (112-710)	351 (104-848)	301 (104-570)
Blood loss (mL)	150 (NC-3270)	100 (NC-3569)	50 (NC-840)
Conversion to laparotomy (n)	2	0	0
Morbidity (n)	7	1	0
Postoperative hospital stay (d)	17 (5-2541)	14 (8-52)	12 (9-30)

Twelve patients in the RH group are also included in the group of UASH. Values are expressed as median (range).

¹Although this patient developed no complication directly related to operative manipulation during and immediately after surgery, her postoperative stay was extended due to uncontrollable massive ascites. NC: Small and non-countable; NH: No history of upper abdominal surgery; RH: Repeat hepatectomy; UASH: Upper abdominal surgery history.

Table 5 Perioperative courses of the patients with laparoscopic liver resection (excluding those with major hepatectomy)

	NH(n = 47)	UASH(n = 21)	RH(n = 12)
Operative time (min)	287 (112-696)	334 (104-682)	301 (104-570)
Blood loss (mL)	100 (NC-3270)	100 (NC-850)	50 (NC-840)
Conversion to laparotomy (n)	2	0	0
Morbidity (n)	5	1	0
Postoperative hospital stay (d)	17 (5-2541)	13 (8-52)	12 (9-30)

Twelve patients in the RH group are also included in the group of UASH. Values are expressed as median (range).

¹Although this patient developed no complication related directly to operative manipulation during and immediately after surgery, her postoperative stay was extended due to uncontrollable massive ascites. NC: Small and non-countable; NH: No history of upper abdominal surgery; RH: Repeat hepatectomy; UASH: Upper abdominal surgery history.

Table 6 Summary of previous reports of laparoscopic repeat hepatectomy

Ref.	n	Age(yr)	Disease	First Hx(open/lap)	Procedure	Bleeding(mL)	Operating time (min)	Con.(n)	POHS (d)	Morbidity	Mortality
Nguyen et al[16]	2		Met
Belli1 et al[15]	12	69 (58-75)	HCC	4:8	LLS (n = 5), Pt (n = 4), Seg (n = 3)	297 ± 134 272.2 ± 120	114.4 ± 11.0 63.9 ± 13.3	1	7.4 ± 2.5 6.2 ± 3.0	26.6%	0%
Hu et al[28]	6	49 (46-61)	HCC	3:3 (Lap RFA, n = 2)	LLS (n = 2), Pt (n = 4)	283.3 ± 256.3	140.8 ± 35.7	0	5.67 ± 1.63	16.7%	0%
Shafaee et al[27]	76	61 (29-82)	Met (n = 63), HCC (n = 3), others (n = 10)	28:44	LLS (n = 4), Pt seg (n = 53), above-seg (n = 19)	300 (0-5000)	180 (80-570)	8	6 (2-42)	26%	0%
Ahn et al[17]	4	57 (54-60)	HCC (n = 3), Met (n =1)	0:4	LLS (n = 1), Pt (n = 3)	481.7 ± 449.5	312.3 ± 158.4	1	10.6 ± 7.4	23.4%	0%
Cannon et al[29]	17
Tsuchiya et al[30]	3	73 (52-79)	HCC	0:3		281.3 (mean)	264.6 (mean)	0	8.6 (mean)		0%
Kanazawa et al[31]	20	70 (46-83)	HCC	15:5	Pt	78 (1-1500)	239 (69-658)	2 (HALS)	9 (5-22)	5%	0%
Montalti et al[32]	9		Met
Present article	12	70 (57-81)	HCC (n = 8), Met (n = 2), others (n = 2)	8:4	Pt (n = 10), Subseg (n = 2)	50 (NC-840)	301 (104-570)	0	12 (9-30)	0%	0%

Data are expressed as median (range) or mean ± SD, unless stated otherwise.

¹In the paper from Belli, operating time, bleeding and POHS are described separately for patients whose previous hepatectomy was open (upper) or laparoscopic (lower). Con: Conversion to laparotomy; HALS: Hand-assisted laparoscopic surgery; HCC: Hepatocellular carcinoma; Hx: Hepatectomy; LAP: Laparoscopic; LLS: Left lateral sectorectomy; Met: Metastasis, NC: Small and non-countable; POHS: Postoperative hospital stay; Pt: Partial resection; RFA: Radiofrequency ablation; Seg: Segmentectomy; Subseg: Subsegmentectomy.