Laparoscopic left hemihepatectomy is suitable as a first step in pure laparoscopic major hepatectomy. Issue 5 (13th July 2018)

• Record Type: Journal Article
• Authors: Hasegawa, Yasushi; Nitta, Hiroyuki; Takahara, Takeshi; Katagiri, Hirokatsu; Kanno, Shoji; Otsuka, Koki; Sasaki, Akira
• Is Part Of: Annals of gastroenterological surgery. Volume 2:Issue 5(2018)
• Page Start: 376
• Page End: 382
• Publication Date: 2018-07-13
• Subjects: laparoscopy -- learning curve -- liver resection -- major hepatectomy; Digestive organs -- Surgery -- Periodicals; 617.43
• DOI: 10.1002/ags3.12193
• Languages: English
• ISSNs: 2475-0328

Abstract

Abstract: Aim: As a procedure, major laparoscopic liver resection (LLR) remains in the exploration phase. Previous studies have assessed major LLR en bloc, including hepatectomies of varying complexities; however, the number of segments alone does not convey the complexity of a resection. This study aimed to assess operative outcomes of LLR procedures with more than one sectionectomy, and to identify the best procedure as a first step when learning to carry out major LLR in order to make LLR a safer, more widely used procedure. Methods: We carried out a retrospective review of the operative outcomes of 120 consecutive patients who underwent pure LLR with more than one sectionectomy. Operative outcomes were compared according to the complexity classification recently published, and the learning curve for each LLR procedure was assessed and compared. Results: Operative outcomes, including operative time, blood loss, and the comprehensive complication index, were significantly stratified according to complexity. There were significant differences in operative outcomes among the medium complexity procedures. The operative time for left hemihepatectomy was the shortest, and the amount of blood loss was the lowest among the medium complexity LLR. Operative times for left hemihepatectomy shortened significantly with time and experience ( r = −0.639), and the slope of the learning curve was steeper than for right hemihepatectomy and right posterior sectionectomy. Conclusion: Left hemihepatectomy is suitable as a first step in pure laparoscopic major hepatectomy and, given its safety and rapid learning curve for surgeons, it could become the gold standard procedure. Abstract : The present study aimed to identify the best procedure as a first step when learning to carry out laparoscopic major hepatectomy. Operative times for left hemihepatectomy shortened significantly and the slope of the learning curve was steeper than for other procedures. Left hemihepatectomy is suitable as a first step in laparoscopic major hepatectomy.