• Endoscopic ultrasound
• Liver diseases
• Portal hypertension

Surgery continues to be the mainstay of treatment of hydatid cysts of the liver. Laparoscopy provides a lesser invasive tool for achieving results same as with the established open surgical techniques. The purpose of the study was to evaluate the feasibility and safety of laparoscopic management of hepatic hydatid disease in children.

It was a prospective randomised study conducted over a period of 7 years. Children with Gharbi Type I, II, III cysts, ≤3 cysts and superficial accessible cysts were treated laparoscopically and their outcomes were compared with matched controls treated by open approach.

Sixty patients were included in the study with thirty patients in each matched group. Thirty paediatric patients (male 12:female 18) with 35 liver hydatid cysts underwent laparoscopic surgery. The mean cyst size was 8.8 ± 2.39 cm. Two patients needed conversion to open. No significant spillage of cyst contents was observed in any of the patients. Duration of hospital stay, time to removal of drains, duration of parenteral analgesia, severity of pain in postoperative period, time to ambulation and time to return to full orals were significantly lower in laparoscopic group compared to open group. Complication rates in both the groups were similar.

With proper patient selection, laparoscopic management of hydatid cysts of the liver in children is feasible and safe option with low morbidity, low rates of conversion and minimal complications.

• Children
• hydatid cyst liver
• laparoscopy
• safety and efficacy

• congenital
• cyst
• infant
• liver
• minimally invasive surgery

•

Echocardiography can demonstrate hepatic cyst–induced right atrial compression.

• Cardiac complication
• Hepatic cyst
• Thrombosis

• Cirrhosis
• Endoscopy
• Liver biopsy
• Liver mass
• Variceal bleeding

To compare King Saud University Medical City experience in laparoscopic liver resection with our previously established database for open resections.

A retrospective study was conducted at King Saud University Medical City, Riyadh, Saudi Arabia. All adult patients who underwent liver resection from 2006 to 2017 were included. Patients who had their procedure converted to open were excluded.

Among the 111 liver resections included, 22 (19.8%) were performed laparoscopically and 89 (80.1%) were performed using the open technique. Malignancy was the most common indication in both groups (78.5%). The mean operative time was 275 min (SD 92.2) in the laparoscopic group versus 315 min (SD 104.3) in the open group. Intraoperative blood transfusion was required in the laparoscopic (9%) and open groups (31.4%). The morbidity rate was 13.6% in the laparoscopic group and 31.4% in the open group, and the mortality rate was 0% in the laparoscopic group and 5.6% in the open group.

Laparoscopic liver resection appears to be a safe technique and can be performed in various benign and malignant cases.

• Adult
• Aged
• Blood Transfusion/statistics & numerical data
• Female
• Hepatectomy/methods
• Hepatectomy/mortality
• Hepatectomy/statistics & numerical data
• Humans
• Intraoperative Care/statistics & numerical data
• Laparoscopy/methods
• Laparoscopy/mortality
• Laparoscopy/statistics & numerical data
• Male
• Middle Aged
• Morbidity
• Operative Time
• Retrospective Studies
• Saudi Arabia/epidemiology
• Tertiary Care Centers/statistics & numerical data
• Time Factors

• Aged
• Aged, 80 and over
• Chi-Square Distribution
• Conversion to Open Surgery/adverse effects
• Conversion to Open Surgery/mortality
• Databases, Factual
• Elective Surgical Procedures
• Female
• Hepatectomy/adverse effects
• Hepatectomy/methods
• Hepatectomy/mortality
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/mortality
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Postoperative Complications/etiology
• Propensity Score
• Risk Factors
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/mortality
• Time Factors
• Treatment Outcome
• United States

Due to important technological developments and improved endoscopic techniques, laparoscopic liver resection (LLR) is now considered the approach of choice and is increasingly performed worldwide. Recent systematic reviews and meta‐analyses of observational data reported that LLR was associated with less bleeding, fewer complications, and no oncological disadvantage; however, no prospective randomized trials have been conducted. LLR will continue to evolve as a surgical approach that improves patient's quality of life. LLR will not totally supplant open liver surgery, and major LLR remains to be technically challenging procedure. The success of LLR depends on individual learning curves and adherence to surgical indications. A recent study proposed a scoring system for stepwise application of LLR, which was based on experience at high‐volume Japanese centers. A cluster of deaths after major LLR was sensationally reported by the Japanese media in 2014. In response, the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery conducted emergency data collection on operative mortality. The results demonstrated that mortality was not higher than that for open procedures except for hemi‐hepatectomy with biliary reconstruction. An online prospective registry system for LLR was established in 2015 to be transparent for patients who might potentially undergo treatment with this newly developed, technically demanding surgical procedure.

• laparoscopic hepatectomy
• laparoscopic liver resection
• liver tumor

To compare short-term results between laparoscopic hepatectomy and open hepatectomy using a propensity score matching.

A patient in the laparoscopic liver resection (LLR) group was randomly matched with another patient in the open liver resection (OLR) group using a 1:1 allocated ratio with the nearest estimated propensity score. Patients of the LLR group without matches were excluded. Matching criteria included age, gender, body mass index, American Society of Anesthesiologists score, potential co-morbidities, hepatopathies, size and number of nodules, preoperative chemotherapy, minor or major liver resections. Intraoperative and postoperative data were compared in both groups.

From January 2012 to January 2015, a total of 241 hepatectomies were consecutively performed, of which 169 in the OLR group (70.1%) and 72 in the LLR group (29.9%). The conversion rate was 9.7% (n = 7). The mortality rate was 4.2% in the OLR group and 0% in the LLR group. Prior to and after propensity score matching, there was a statistically significant difference favorable to the LLR group regarding shorter operative times (185 min vs 247.5 min; P = 0.002), less blood loss (100 mL vs 300 mL; P = 0.002), a shorter hospital stay (7 d vs 9 d; P = 0.004), and a significantly lower rate of medical complications (4.3% vs 26.4%; P < 0.001).

Laparoscopic liver resections seem to yield better short-term and mid-term results as compared to open hepatectomies and could well be considered a privileged approach and become the gold standard in carefully selected patients.

• Laparoscopic hepatectomy
• Morbidity and mortality
• Hepatocellular carcinoma
• Liver resection
• Colorectal metastases
• Open hepatectomy
• Propensity score matching

• 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

• hepatic polycystic disease
• laparoscopic management
• simple hepatic cysts

• Adult
• Aged
• Aged, 80 and over
• Cysts/diagnosis
• Cysts/diagnostic imaging
• Cysts/surgery
• Female
• Humans
• Laparoscopy
• Liver Diseases/diagnosis
• Liver Diseases/diagnostic imaging
• Liver Diseases/surgery
• Male
• Middle Aged
• Retrospective Studies
• Tomography, X-Ray Computed
• Ultrasonography
• Young Adult

Aim. To evaluate the feasibility of percutaneous sclerotherapy of symptomatic simple abdominal cysts, using hypertonic saline and bleomycin, as an alternative to surgery. Materials and Methods. This study involved fourteen consecutive patients (ten women, four men, mean age: 59.2 y) with nineteen symptomatic simple cysts (liver n = 14, kidney n = 3, and adrenal n = 2) treated percutaneously using a modified method. Initially CT-guided drainage was performed; the next day the integrity of the cyst/exclusion of extravasation or communications was evaluated under fluoroscopy, followed by two injections/reabsorptions of the same quantity of hypertonic NaCl 15% solution and three-time repetition of the same procedure with the addition of bleomycin. The catheter was then removed; the patients were hospitalized for 12 hours and underwent follow-ups on 1st, 3rd, 6th, and 12th months. Cyst's volumes and the reduction rate (%) were calculated in each evaluation. Results. No pain or complications were noted. A significant cyst's volume reduction was documented over time (P < 0.001). On the 12th month 17 cysts disappeared and two displayed a 98.7% and 68.9% reduction, respectively. Conclusion. This percutaneous approach constitutes a very promising nonsurgical alternative for patients with symptomatic simple cyst, without complications under proper precautions, leading to eliminating the majority of cysts.

A review was carried out in Medline, LILACS and the Cochrane Library. Our database search strategy included the following terms: “hydatid cyst”, “liver”, “management”, “meta-analysis” and “randomized controlled trial”. No language limits were used in the literature search. The latest electronic search date was the 7^th of January 2014. Inclusion and exclusion criteria: all relevant studies on the assessment of therapeutic methods for hydatid cysts of the liver were considered for analysis. Information from editorials, letters to publishers, low quality review articles and studies done on animals were excluded from analysis. Additionally, well-structured abstracts from relevant articles were selected and accepted for analysis. Standardized forms were designed for data extraction; two investigators entered the data on patient demographics, methodology, recurrence of HC, mean cyst size and number of cysts per group. Four hundred and fourteen articles were identified using the previously described search strategy. After applying the inclusion and exclusion criteria detailed above, 57 articles were selected for final analysis: one meta-analysis, 9 randomized clinical trials, 5 non-randomized comparative prospective studies, 7 non-comparative prospective studies, and 34 retrospective studies (12 comparative and 22 non-comparative). Our results indicate that antihelminthic treatment alone is not the ideal treatment for liver hydatid cysts. More studies in the literature support the effectiveness of radical treatment compared with conservative treatment. Conservative surgery with omentoplasty is effective in preventing postoperative complications. A laparoscopic approach is safe in some situations. Percutaneous drainage with albendazole therapy is a safe and effective alternative treatment for hydatid cysts of the liver. Radical surgery with pre- and post-operative administration of albendazole is the best treatment option for liver hydatid cysts due to low recurrence and complication rates.

• Hydatid
• Liver Cyst
• Echinococcosis
• PAIR
• Cystectomy

• Albendazole/administration & dosage
• Albendazole/adverse effects
• Antiparasitic Agents/administration & dosage
• Antiparasitic Agents/adverse effects
• Combined Modality Therapy
• Drainage/adverse effects
• Drainage/methods
• Echinococcosis, Hepatic/diagnosis
• Echinococcosis, Hepatic/parasitology
• Echinococcosis, Hepatic/therapy
• Humans
• Laparoscopy/adverse effects
• Recurrence
• Treatment Outcome

• Hepatic cyst
• Laparoscopy
• Posterosuperior

• Echinococcosis
• Laparoscopy
• Liver
• Morbidity
• Mortality

• Adult
• Aged
• Cysts/blood supply
• Cysts/pathology
• Cysts/surgery
• Cysts/therapy
• Drainage
• Ethanol/therapeutic use
• Female
• Humans
• Laparoscopy
• Liver/blood supply
• Liver/drug effects
• Liver/pathology
• Liver/surgery
• Male
• Middle Aged
• Sclerotherapy/methods
• Treatment Outcome

We sought to evaluate the feasibility and outcomes of laparoscopic resection of giant hepatic cysts and surgical success, focusing on cyst recurrence.

From February 2004 to August 2011, 37 consecutive patients with symptomatic hepatic cysts were evaluated and treated at Dong-A University Hospital. Indications were simple cysts (n = 20), multiple cysts (n = 6), polycystic disease (n = 2), and cystadenoma (n = 9).

The median patient age was 64 years, with a mean lesion diameter of 11.4 cm. The coincidence between preoperative imaging and final pathologic diagnosis was 54% and half (n = 19) of the cysts were located in segments VII and VIII. Twenty-two patients had American Society of Anesthesiologists (ASA) classification I and II, and nine had ASA classification III. Surgical treatment of hepatic cysts were open liver resection (n = 3), laparoscopic deroofing (n = 24), laparoscopic cyst excision (n = 4), laparoscopic left lateral sectionectomy (n = 2), hand assisted laparoscopic procedure (n = 2), and single port laparoscopic deroofing (n = 2). The mean fellow-up was 21 months, and six patients (16%) experienced radiographic-apparent recurrence. Reoperation due to recurrence was performed in two patients. Among the factors predicting recurrence, multivariate analysis revealed that interventional radiological procedures and pathologic diagnosis were statistically significant.

Laparoscopic resection of giant hepatic cysts is a simple and effective method to relieve symptoms with minimal surgical trauma. Moreover, the recurrence is dependent on the type of pathology involved, and the sclerotherapy undertaken.

• Hepatic cyst
• Laparoscopy
• Liver

Hydatidosis is endemic in the Mediterranean region including morrocco, the Middle and Far East, Australia, New Zealand, and South America—all areas where animal husbandry is common. Rupture into the abdominal cavity is a rare but serious complication of hydatid disease. The cysts may be ruptured after a trauma, or spontaneously as a result of increased intracystic pressure. Rupture of the hydatid cyst requires emergency surgical intervention.

Fourteen patients received surgical treatment for intraperitoneal rupture of the cysts over a period of 5 years. Age, gender, time to surgery from the onset of the symptoms, laboratory findings, diagnostic procedures, surgical treatment modalities, in-hospital stay, morbidity, mortality and recurrence were evaluated retrospectively.

Eight of the patients were men and six were women. All of the patients had signs of peritoneal irritation. One patient (7,14%) had a history of blunt abdominal trauma. Ultrasonography scans revealed intra-abdominal fluid in all cases, intraperitoneal multiple cysts in 11 cases and heterogeneous cavity or cystic structures in the liver in 12 cases. Computed tomography showed multiple cystic lesions in the liver and peritoneum with intra-abdominal free fluid. The ruptured cysts were located in the right lobe of the liver in seven patients, in the left lobe in six patients and in both lobes in one patients. Procedures to fill the cystic cavities were applied after removal of the intraperitoneal fluid. Partial pericystectomy and drainage was the most frequent surgical procedure. No patients died in the early postoperative period. A total of seven morbidities developed in six patients (35.3%). Median hospital stay was 08 days and median follow-up was 12 months. Intra-abdominal recurrence occurred in one case (7.7%).

Rupture of hydatid cysts into the peritoneal cavity, although rare, presents a challenge for surgeons. This pathology should be included in the differential diagnosis of acute abdomen in endemic areas. The operative procedures, either radical or conservative, should be based on the patient’s condition, the regional characteristics, and the surgeon’s experience. The morbidity and mortality rates of surgical interventions for ruptured hydatid cysts are higher than the rates for elective uncomplicated cases.

• Abdomen
• Echinococcosis
• Peritonitis
• Surgery

Complications appear to be lower in laparoscopic cases versus open cases for anterolateral and posterosuperior hepatic segment surgery.

Minimally invasive surgery for liver resection remains controversial. This study was designed to compare open versus laparoscopic surgical approaches to liver resection.

We performed a single-center retrospective chart review.

We compared 45 laparoscopic liver resections with 17 open cases having equivalent resections based on anatomy and diagnosis. The overall complication rate was 25.8%. More open resection patients had complications (52.9% vs 15.5%, P < .008). The conversion rate was 11.1%. The mean blood loss was 667.1 ± 1450 mL in open cases versus 47.8 ± 89 mL in laparoscopic cases (P < .0001). Measures of intravenous narcotic use, intensive care unit length of stay, and hospital length of stay all favored the laparoscopic group. Patients were more likely to have complications or morbidity in the open resection group than in the laparoscopic group for both the anterolateral (P < .085) and posterosuperior (P < .002) resection subgroups.

In this series comparing laparoscopic and open liver resections, there were fewer complications, more rapid recovery, and lower morbidity in the laparoscopic group, even for those resections involving the posterosuperior segments of the liver.

Surgery has the potential to remove the entire hydatid cyst and can lead to complete cure. Presence of hydatid cysts in multiple abdominal organs imposes special challenges for laparoscopic management. The patient position and port placement for one organ may not be adequate for other and proper exposure in hydatid cyst is of paramount importance to prevent spillage and complete removal of the cyst. Single incision multi-trocar technique has a unique advantage of allowing surgeon to work in different quadrants of abdomen using the same incision and ports. We report in this paper the first Laparo-endoscopic single-site hepatic cyst excision with partial splenectomy for hydatid cyst in liver and spleen using conventional laparoscopic instruments.

The procedure was performed on a 64 year old female diagnosed to have Hydatid cyst in segment VIII of liver and another cyst in lower pole of spleen a transverse 3 cm incision was made 6 cm above umbilicus and was deepened up to fascia. Two 10mm and one 5mm ports were inserted. Procedure was completed in 160 minutes without any intra-operative complication. There were no post-operative complication and patient was discharged on day 5.

Single incision multi-trocar surgery has cosmetic advantage over standard laparoscopic approach. It is even more marked when two procedures are combined in different quadrants of abdomen. As this is a rare combination procedure so it remains to be determined if this technique offers additional advantages of decreased analgesia, decreased hospital stay or cost effectiveness.

• Hydatid cyst
• hydatid disease of spleen
• partial splenectomy
• single incision multi-trocar surgery
• single incision surgery

• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Hepatocellular/complications
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/surgery
• China/epidemiology
• Disease-Free Survival
• Female
• Follow-Up Studies
• Hepatectomy/methods
• Humans
• Laparoscopy
• Length of Stay/trends
• Liver Cirrhosis/complications
• Liver Cirrhosis/surgery
• Liver Neoplasms/complications
• Liver Neoplasms/mortality
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Retrospective Studies
• Survival Analysis
• Survival Rate/trends
• Time Factors

Focal nodular hyperplasia is a benign liver lesion incidentally discovered with increasing frequency because of the proliferation of imaging studies. Radiographic characterization can diagnose this pathologic lesion and nonoperative therapy is the standard of care. However, surgical resection may be required for diagnostic reasons or symptomatic patients. Depending on the anatomic location of the lesion, biopsy and/or resection can be performed laparoscopically. We herein report the case of a 26-year-old Japanese woman with a hepatic tumor who required a medical examination. Her medical history was negative for alcohol abuse, oral contraceptive administration and trauma. Clinical examination showed no significant symptoms. Ultrasonography, computed tomography and magnetic resonance imaging showed a mass located in the left lateral segment of the liver with a diameter of about 40 mm. It was difficult to diagnose the tumor definitively from these imaging studies, so we performed laparoscopic partial hepatectomy with successive firing of endoscopic staplers. The histopathological diagnosis was focal nodular hyperplasia. Surgical procedures and postoperative course were uneventful and the patient was discharged from the hospital on postoperative day 5.

• Benign liver tumor
• Focal nodular hyperplasia
• Laparoscopic partial hepatectomy

• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Hepatocellular/surgery
• Constriction
• Female
• Hand-Assisted Laparoscopy
• Hepatectomy/instrumentation
• Hepatectomy/methods
• Humans
• Laparoscopy/instrumentation
• Liver Cirrhosis/surgery
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Tourniquets

• hepatocellular adenoma
• liver adenoma
• malignant transformation
• hepatic adenoma
• frequency
• hepatocellular carcinomas

AIM: To summarize the clinical experience of laparoscopic hepatectomy at a single center.

METHODS: Between November 2003 and March 2009, 78 patients with hepatocellular carcinoma (n = 39), metastatic liver carcinoma (n = 10), and benign liver neoplasms (n = 29) underwent laparoscopic hepatectomy in our unit. A retrospective analysis was done on the clinical outcomes of the 78 patients.

RESULTS: The lesions were located in segments I (n = 3), II (n = 16), III (n = 24), IV (n = 11), V (n = 11), VI (n = 9), and VIII (n = 4). The lesion sizes ranged from 0.8 to 15 cm. The number of lesions was three (n = 4), two (n = 8) and one (n = 66) in the study cohort. The surgical procedures included left hemi-hepatectomy (n = 7), left lateral lobectomy (n = 14), segmentectomy (n = 11), local resection (n = 39), and resection of metastatic liver lesions during laparoscopic surgery for rectal cancer (n = 7). Laparoscopic liver resection was successful in all patients, with no conversion to open procedures. Only four patients received blood transfusion (400-800 mL). There were no perioperative complications, such as bleeding and biliary leakage. The liver function of all patients recovered within 1 wk, and no liver failure occurred.

CONCLUSION: Laparoscopic hepatectomy is a safe and feasible operation with minimal surgical trauma. It should be performed by a surgeon with sufficient experience in open hepatic resection and who is proficient in laparoscopy.

• Hepatectomy
• Laparoscopy
• Liver neoplasms

• hepatectomy
• laparoscopy
• oncology

• Ascites/etiology
• Humans
• Pancreatic Cyst/surgery
• Postoperative Complications/etiology
• von Hippel-Lindau Disease/complications