• minimally invasive liver surgery
• robotic liver surgery
• laparoscopic liver surgery
• learning curve
• surgical outcomes
• surgical training

• Bile
• Carcinoma, Hepatocellular/surgery
• Hepatectomy/adverse effects
• Humans
• Incidence
• Laparoscopy/adverse effects
• Length of Stay
• Liver Neoplasms/surgery
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Postoperative Complications/surgery
• Propensity Score
• Retrospective Studies

• Bisectionectomy
• Case series
• Central hepatectomy
• Primary liver malignancies
• Robotic
• Secondary liver malignancies

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

Technological innovations have made it possible to use laparoscopic liver resection in cases with pre-existing adhesions or cicatricial changes. However, laparoscopic repeat liver resection (LRLR) still represents a challenge for surgeons, especially in case of previous open liver surgery. This study evaluated the outcomes of LRLR after open liver resection (OLR) in cases of recurrent liver cancer.

A total of 62 patients who underwent laparoscopic minor liver resection at our institution between September 2012 and September 2016 were retrospectively divided into an LRLR group (n = 13) and a laparoscopic primary liver resection group (LPLR; n = 49). The two groups were compared in terms of patient demographics, surgical procedures and short-term outcomes. Recurrence-free survival (RFS) and overall survival (OS) were compared for patients with hepatocellular carcinoma (HCC) or colorectal liver metastases (CRLMs).

There was a significant intergroup difference in the hepatitis virus background, although the two groups' primary histology and pre-operative liver function were comparable. The two groups had statistically similar values for extent of resection, operative time, estimated blood loss, transfusion requirement, conversion to laparotomy, post-operative complications, surgical margins, time to oral intake and hospital stay. No significant differences were detected when we stratified the cases according to low and intermediate difficulty. Furthermore, there were no intergroup differences in RFS or OS in the two groups for patients with HCC and CRLM.

The findings suggest that minor LRLR after OLR is safe and comparable with minor LPLR in the present study.

• Difficulty score
• laparoscopic
• minor liver resection
• previous open liver resection
• repeat liver resection
• short-term outcomes

• Colorectal liver metastases
• Laparoscopic liver surgery
• Liver surgery

• Laparoscopic liver resection
• Meta-analysis
• Open liver resection
• Recurrent hepatocellular carcinoma

• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/surgery
• Hepatectomy/methods
• Humans
• Laparoscopy/methods
• Length of Stay
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Neoplasm Recurrence, Local/mortality
• Neoplasm Recurrence, Local/pathology
• Neoplasm Recurrence, Local/surgery
• Open Abdomen Techniques/methods
• Operative Time
• Postoperative Complications
• Retrospective Studies
• Treatment Outcome

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

Liver resection (LR) is now actively applied to intrahepatic recurrence of liver metastases and hepatocellular carcinoma. Although indications of laparoscopic LR (LLR) have been expanded, there are increased risks of intraoperative complications and conversion in repeat LLR. Controversy still exists for the indication. There are 16 reports of small series to date. These studies generally reported that repeat LLR has better short-term outcomes than open (reduced bleedings, less or similar morbidity and shorter hospital stay) without compromising the long-term outcomes. The fact that complete adhesiolysis can be avoided in repeat LLR is also reported. In the comparison of previous procedures, it is reported that the operation time for repeat LLR was shorter for the patients previously treated with LLR than open. Furthermore, it is speculated that LLR for minor repeat LR of cirrhotic liver can be minimized the deterioration of liver function by LR. However, further experience and evaluation of anatomical resection or resections exposing major vessels as repeat LLR, especially after previous anatomical resection, are needed. There should be a chance to prolong the overall survival of the patients by using LLR as a powerful local therapy which can be applied repeatedly with minimal deterioration of liver function.

• Hepatocellular carcinoma
• Laparoscopic liver resection
• Repeat surgery
• Metastasis

• Evolution of minimally invasive hepatectomy
• Laparoscopic hepatectomy
• Laparoscopic liver
• Minimally invasive hepatectomy
• Robotic hepatectomy
• Robotic liver

• Hepatocellular carcinoma
• Laparoscopic hepatectomy
• Laparoscopic liver resection
• Liver malignant disease
• Minimally invasive surgery
• Surgical excision

• Experience
• Laparoscopic hepatectomy
• Laparoscopic liver resection
• Robotic hepatectomy
• Robotic liver resection

• Laparoscopic
• Liver resection
• Radiofrequency-assisted

Laparoscopic liver resection has become an accepted treatment for liver tumors or intrahepatic bile duct stones, but its application in patients with previous upper abdominal surgery is controversial. The aim of this study was to evaluate the feasibility and safety of laparoscopic hepatectomy in these patients.

Three hundred and thirty-six patients who underwent laparoscopic hepatectomy at our hospital from March 2012 to June 2015 were enrolled in the retrospective study. They were divided into two groups: Those with previous upper abdominal surgery (PS group, n = 42) and a control group with no previous upper abdominal surgery (NS group, n = 294). Short-term outcomes including operating time, blood loss, hospital stay, morbidity, and mortality were compared among the groups.

There was no significant difference in median operative duration between the PS group and the NS group (180 min vs. 160 min, P = 0.869). Median intraoperative blood loss was same between the PS group and the control group (200 ml vs. 200 ml, P = 0.907). The overall complication rate was significantly lower in the NS group than in the PS group (17.0% vs. 31.0%, P = 0.030). Mortality and other short-term outcomes did not differ significantly between groups.

Our study showed no significant difference between the PS group and NS group in term of short-term outcomes. Laparoscopic hepatectomy is a feasible and safe procedure for patients with previous upper abdominal surgery.

• hepatopancreaticoduodenectomy
• laparoscopic repeat hepatectomy
• recurrent perihilar cholangiocarcinoma

Laparoscopic hepatectomy is increasingly being used to treat hepatocellular carcinoma (HCC). However, few studies have examined the treatment of recurrent HCC in patients who received a prior hepatectomy. The present prospective study compared the clinical efficacy of laparoscopic surgery with conventional open surgery in HCC patients with postoperative tumor recurrence.

We conducted a prospective study of 64 patients, all of whom had undergone open surgery once before, who were diagnosed with recurrent HCC between June 2014 and November 2014. The laparoscopic group (n = 31) underwent laparoscopic hepatectomy, and the control group (n = 33) underwent conventional open surgery. Operation time, intraoperative blood loss, surgical margins, postoperative pain scores, postoperative time until the patient could walk, anal exsufflation time, length of hospital stay, and inpatient costs were compared between the two groups. The patients were followed up for 1 year after surgery, and relapse-free survival was compared between the two groups.

All surgeries were successfully completed. No conversion to open surgery occurred in the laparoscopic group, and no serious postoperative complications occurred in either group. No significant difference in inpatient costs was found between the laparoscopic group and the control group (P = 0.079), but significant differences between the two groups were observed for operation time (116.7 ± 37.5 vs. 148.2 ± 46.7 min, P = 0.031), intraoperative blood loss (117.5 ± 35.5 vs. 265.9 ± 70.3 mL, P = 0.012), postoperative time until the patient could walk (1.6 ± 0.6 vs. 2.2 ± 0.8 days, P < 0.05), anal exsufflation time (2.1 ± 0.3 vs. 2.8 ± 0.7 days, P = 0.041), visual analogue scale pain score (P < 0.05), postoperative hepatic function (P < 0.05), and length of hospital stay (4.5 ± 1.3 vs. 6.0 ± 1.2 days, P = 0.014). During the 1-year postoperative follow-up period, 6 patients in each group had recurrent HCC on the side of the initial operation, but no significant difference between groups was observed in the recurrence rate or relapse-free survival. In the laparoscopic group, operation time, postoperative time until the patient could walk, anal exsufflation time, and inpatient costs were not different (P > 0.05) between the patients with contralateral HCC recurrence (n = 18) and those with ipsilateral HCC recurrence (n = 13). However, intraoperative blood loss was significantly less (97.7 ± 14.0 vs. 186.3 ± 125.6 mL, P = 0.012) and the hospital stay was significantly shorter (4.2 ± 0.7 vs. 6.1 ± 1.7 days, P = 0.021) for the patients with contralateral recurrence than for those with ipsilateral recurrence.

For the patients who previously underwent conventional open surgical resection of HCC, complete laparoscopic resection was safe and effective for recurrent HCC and resulted in a shorter operation time, less intraoperative blood loss, and a faster postoperative recovery than conventional open surgery. Laparoscopic resection was especially advantageous for the patients with contralateral HCC recurrence.

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

• Abdominal drainage
• Bile leakage
• Laparoscopic major hepatectomy
• Postoperative complications

• 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

• Inferior vena cava
• inferior vena cava filter
• inferior vena cava filter retrieval
• laparoscopy

• Financial benefit
• Hospital cost
• Laparoscopic hepatectomy
• Open hepatectomy
• Patient satisfaction

• hepatocellular carcinoma
• laparoscopic liver resection
• metastases

• Aged
• Carcinoma, Hepatocellular/surgery
• Female
• Humans
• Laparoscopy/adverse effects
• Liver/surgery
• Liver Neoplasms/surgery
• Neoplasm Seeding

• Bleeding control
• Blood loss
• Hepatectomy
• Laparoscopy
• Liver resection

• Hand-assisted
• Hepatectomy
• Hybrid
• Laparoscopic liver resection
• Laparoscopy-assisted

AIM: To assess clinical outcomes of laparoscopic hepatectomy (LH) in patients with a history of upper abdominal surgery and repeat hepatectomy.

METHODS: This study compared the perioperative courses of patients receiving LH at our institution that had or had not previously undergone upper abdominal surgery. Of the 80 patients who underwent LH, 22 had prior abdominal surgeries, including hepatectomy (n = 12), pancreatectomy (n = 3), cholecystectomy and common bile duct excision (n = 1), splenectomy (n = 1), total gastrectomy (n = 1), colectomy with the involvement of transverse colon (n = 3), and extended hysterectomy with extensive lymph-node dissection up to the upper abdomen (n = 1). Clinical indicators including operating time, blood loss, hospital stay, and morbidity were compared among the groups.

RESULTS: Eighteen of the 22 patients who had undergone previous surgery had severe adhesions in the area around the liver. However, there were no conversions to laparotomy in this group. In the 58 patients without a history of upper abdominal surgery, the median operative time was 301 min and blood loss was 150 mL. In patients with upper abdominal surgical history or repeat hepatectomy, the operative times were 351 and 301 min, and blood loss was 100 and 50 mL, respectively. The median postoperative stay was 17, 13 and 12 d for patients with no history of upper abdominal surgery, patients with a history, and patients with repeat hepatectomy, respectively. There were five cases with complications in the group with no surgical history, compared to only one case in the group with a prior history. There were no statistically significant differences in the perioperative results between the groups with and without upper abdominal surgical history, or with repeat hepatectomy.

CONCLUSION: LH is feasible and safe in patients with a history of upper abdominal surgery or repeat hepatectomy.

• Chronic liver disease
• Laparoscopic hepatectomy
• Liver tumor
• Repeat hepatectomy
• Surgical history

• Abdomen/surgery
• Aged
• Aged, 80 and over
• Blood Loss, Surgical
• Feasibility Studies
• Female
• Hepatectomy/adverse effects
• Hepatectomy/methods
• Humans
• Japan
• Laparoscopy/adverse effects
• Length of Stay
• Male
• Middle Aged
• Operative Time
• Peritoneal Diseases/diagnosis
• Peritoneal Diseases/etiology
• Postoperative Complications/etiology
• Reoperation
• Time Factors
• Tissue Adhesions
• Treatment Outcome

AIM: To study costs of laparoscopic and open liver and pancreatic resections, all the compiled data from available observational studies were systematically reviewed.

METHODS: A systematic review of the literature was performed using the Medline, Embase, PubMed, and Cochrane databases to identify all studies published up to 2013 that compared laparoscopic and open liver [laparoscopic hepatic resection (LLR) vs open liver resection (OLR)] and pancreatic [laparoscopic pancreatic resection (LPR) vs open pancreatic resection] resection. The last search was conducted on October 30, 2013.

RESULTS: Four studies reported that LLR was associated with lower ward stay cost than OLR (2972 USD vs 5291 USD). The costs related to equipment (3345 USD vs 2207 USD) and theatre (14538 vs 11406) were reported higher for LLR. The total cost was lower in patients managed by LLR (19269 USD) compared to OLR (23419 USD). Four studies reported that LPR was associated with lower ward stay cost than OLR (6755 vs 9826 USD). The costs related to equipment (2496 USD vs 1630 USD) and theatre (5563 vs 4444) were reported higher for LPR. The total cost was lower in the LPR (8825 USD) compared to OLR (13380 USD).

CONCLUSION: This systematic review support the economic advantage of laparoscopic over open approach to liver and pancreatic resection.

• Hepatobiliary resection
• Laparoscopic hepatic resection
• Open liver resection
• Laparoscopic pancreatic resection
• Open pancreatic resection

• Cost Savings
• Cost-Benefit Analysis
• Hepatectomy/economics
• Hepatectomy/methods
• Hospital Costs
• Humans
• Laparoscopy/economics
• Laparoscopy/methods
• Pancreatectomy/economics
• Pancreatectomy/methods
• Treatment Outcome

• colorectal liver metastasis
• colorectalis májáttét
• hepatocellular carcinoma
• hepatocellularis carcinoma
• laparoscopic liver surgery
• laparoscopos májresectio

• hepatectomy
• laparoscopy
• left
• pigs
• technique

• Adolescent
• Adult
• Aged
• Echinococcosis, Hepatic/mortality
• Echinococcosis, Hepatic/surgery
• Feasibility Studies
• Female
• Follow-Up Studies
• Hepatectomy/methods
• Humans
• Laparoscopy/methods
• Male
• Middle Aged
• Postoperative Complications/epidemiology
• Recurrence
• Retrospective Studies
• Treatment Outcome
• Young Adult

• Benign liver tumours
• Cirugía hepática
• Cirugía hepática laparoscópica
• Hepatic metastases
• Hepatocarcinoma
• Laparoscopic liver surgery
• Liver surgery
• Metástasis hepáticas
• Tumores hepáticos benignos

• Adult
• Aged
• Aged, 80 and over
• Female
• Hepatectomy/methods
• Hepatectomy/statistics & numerical data
• Humans
• Laparoscopy
• Liver Diseases/surgery
• Male
• Middle Aged
• Young Adult

Robotic liver surgery was found to offer advantages not inherent in conventional laparoscopic liver resection.

Robotic-assisted surgery offers a solution to fundamental limitations of conventional laparoscopic surgery, and its use is gaining wide popularity. However, the application of this technology has yet to be established in hepatic surgery.

A retrospective analysis of our prospectively collected liver surgery database was performed. Over a 6-month period, all consecutive patients who underwent robotic-assisted hepatic resection for a liver neoplasm were included. Demographics, operative time, and morbidity encountered were evaluated.

A total of 7 robotic-assisted liver resections were performed, including 2 robotic-assisted single-port access liver resections with the da Vinci-Si Surgical System (Intuitive Surgical Sunnyvalle, Calif.) USA. The mean age was 44.6 years (range, 21–68 years); there were 5 male and 2 female patients. The mean operative time (± SD) was 61.4 ± 26.7 minutes; the mean operative console time (± SD) was 38.2 ± 23 minutes. No conversions were required. The mean blood loss was 100.7 mL (range, 10–200 mL). The mean hospital stay (± SD) was 2 ± 0.4 days. No postoperative morbidity related to the procedure or death was encountered.

Our initial experience with robotic liver resection confirms that this technique is both feasible and safe. Robotic-assisted technology appears to improve the precision and ergonomics of single-access surgery while preserving the known benefits of laparoscopic surgery, including cosmesis, minimal morbidity, and faster recovery.

• Benign liver tumours
• Cirugía hepática
• Cirugía hepática laparoscópica
• Hepatic metastases
• Hepatocarcinoma
• Laparoscopic liver surgery
• Liver surgery
• Metástasis hepáticas
• Tumores hepáticos benignos

• Diagnosis, Differential
• Diagnostic Imaging
• Female
• Humans
• Leiomyoma/diagnosis
• Leiomyoma/pathology
• Leiomyoma/surgery
• Liver Neoplasms/diagnosis
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Male
• Middle Aged