Laparoscopic vs. open left lateral hepatectomy
Department of Hepatology, Imperial College Healthcare NHS Trust, 10th floor, QEQM Wing, St Mary's Hospital, South Wharf Street, London W2 1NY, UK. Expert review of gastroenterology & hepatology
(Impact Factor: 2.42).
09/2009; 3(4):345-51. DOI: 10.1586/egh.09.36
Laparoscopic liver surgery is becoming more popular, and many high-volume liver centers are now gaining expertise in this area. Laparoscopic left lateral hepatectomy (LLLH) is a standardized and anatomically well-defined resection and may transform into a primarily laparoscopic procedure for cancer surgery or living donor hepatectomy for transplantation. Five case-control series were identified comparing a total of 167 cases (86 cases of LLLH plus 81 cases of open left lateral hepatectomy). Groups were matched by age and sex, with broadly similar indications for surgery and resection techniques. LLLH is associated with shorter hospital stays and less blood loss without compromising the margin status or increasing complication rates. Donors of LLLH grafts did not have higher graft-related morbidity. Prospective studies are required to define the safety in terms of disease-free and overall survival in this new avenue in laparoscopic liver surgery.
Available from: Frederik Berrevoet
- "Since the publication of the first nonanatomic liver resection and the first left lateral lobectomy, laparoscopic liver resection has been widely and increasingly performed for a variety of benign and malignant diseases [18, 19]. The development of this technique has been limited during this time due to difficulty reproducing basic open liver surgery maneuvers, risks of bleeding and pulmonary embolism, and fear of compromising oncologic resection by tumoral cell seeding [20, 21]. "
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ABSTRACT: Laparoscopic left lateral sectionectomy (LLS) has gained popularity in its use for benign and malignant tumors. This report describes the evolution of the authors' experience using laparoscopic LLS for different indications including living liver donation.
Between January 2004 and January 2009, 37 consecutive patients underwent laparoscopic LLS for benign, primary, and metastatic liver diseases, and for one case of living liver donation. Resection of malignant tumors was indicated for 19 (51%) of the 37 patients.
All but three patients (deceased due to metastatic cancer disease) are alive and well after a median follow-up period of 20 months (range, 8-46 months). Liver cell adenomas (72%) were the main indication among benign tumors, and colorectal liver metastases (84%) were the first indication of malignancy. One case of live liver donation was performed. Whereas 16 patients (43%) had undergone a previous abdominal surgery, 3 patients (8%) had LLS combined with bowel resection. The median operation time was of 195 min (range, 115-300 min), and the median blood loss was of 50 ml (range, 0-500 ml). Mild to severe steatosis was noted in 7 patients (19%) and aspecific portal inflammation in 11 patients (30%). A median free margin of 5 mm (range, 5-27 mm) was achieved for all cancer patients. The overall recurrence rate for colorectal liver metastases was of 44% (7 patients), but none recurred at the surgical margin. No conversion to laparotomy was recorded, and the overall morbidity rate was 8.1% (1 grade 1 and 2 grade 2 complications). The median hospital stay was 6 days (range, 2-10 days).
Laparoscopic LLS without portal clamping can be performed safely for cases of benign and malignant liver disease with minimal blood loss and overall morbidity, free resection margins, and a favorable outcome. As the ultimate step of the learning curve, laparoscopic LLS could be routinely proposed, potentially increasing the donor pool for living-related liver transplantation.
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ABSTRACT: A short presentation of the unpublished Research Report No 217, by Osvaldo Goscinski, from the Quantum Chemistry Group at Uppsala University is made. The Report has the title “Conjugate Eigenvalue Problems and the Theory of Upper and Lower Bounds”. Some justification of its verbatim inclusion in this Volume in honour of Per-Olov Löwdin, is made. It is essentially motivated by the attention that the theory presented there has received in the field of Generalized and Molecular Sturmians. Current work by John Avery and collaborators is alluded to. It is included as an Appendix.
Available from: wjgnet.com
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