Evolution of laparoscopic left lateral sectionectomy without the Pringle maneuver: through resection of benign and malignant tumors to living liver donation

• Published in: Surgical endoscopy Vol. 25; no. 1; pp. 79 - 87
• Main Authors: Troisi, Roberto Ivan, Van Huysse, Jacques, Berrevoet, Frederik, Vandenbossche, Bert, Sainz-Barriga, Mauricio, Vinci, Alessio, Ricciardi, Salvatore, Bocchetti, Tommaso, Rogiers, Xavier, de Hemptinne, Bernard
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.01.2011; Springer; Springer Nature B.V
• Subjects: Abdomen; Abdominal Surgery; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Adenoma - surgery; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Blood Loss, Surgical; Camptothecin - administration & dosage; Camptothecin - analogs & derivatives; Carcinoma, Hepatocellular - drug therapy; Carcinoma, Hepatocellular - surgery; Combined Modality Therapy; Digestive system. Abdomen; Disease; Disease-Free Survival; Endoscopy; Female; Fluorouracil - administration & dosage; Follow-Up Studies; Gastroenterology; Gastrointestinal Stromal Tumors - secondary; Gastrointestinal Stromal Tumors - surgery; Gynecology; Hepatectomy - methods; Hepatology; Hospitals; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Laparoscopy - methods; Length of Stay - statistics & numerical data; Leucovorin - administration & dosage; Liver; Liver Neoplasms - drug therapy; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Living Donors; Male; Medical sciences; Medicine; Medicine & Public Health; Melanoma - secondary; Melanoma - surgery; Metastasis; Middle Aged; Morbidity; Mortality; Organoplatinum Compounds - administration & dosage; Patients; Postoperative Complications - epidemiology; Proctology; Retrospective Studies; Surgeons; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Surgical techniques; Tissue and Organ Harvesting - methods; Tomography; Transplants & implants; Tumors; Belgium; Left lateral sectionectomy; Pringle maneuver; Living liver donors; Laparoscopic liver surgery; Repeat hepatectomy; Human; Endoscopic surgery; Left; Digestive system; Liver; Laparoscopic surgery; Laparoscopy; Malignant tumor; Hepatectomy; Treatment; Endoscopy; Benign neoplasm; Cancer
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-010-1133-8

Background 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. Methods 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. Results 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). Conclusions 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.