Abstract and Background
Abstract
Background: Laparoscopic liver surgery is becoming increasingly common. This cohort study was designed to directly compare perioperative outcomes of the left lateral segmentectomy via laparoscopic and open approach.
Methods: Between 2002 and 2006 43 left lateral segmentectomies were performed at King's College Hospital. Those excluded from analysis included previous liver resections, polycystic liver disease, liver cirrhosis and synchronous operations. Of 20 patients analysed, laparoscopic (n = 10) were compared with open left lateral segmentectomy (n = 10). Both groups had similar patient characteristics.
Results: Morbidity rates were similar with no wound or chest infection in either group. The conversion rate was 10% (1/10). There was no difference in operating time between the groups (median time 220 minutes versus 179 minutes, p = 0.315). Surgical margins for all lesions were clear. Less postoperative opiate analgesics were required in the laparoscopic group (median 2 days versus 5 days, p = 0.005). The median postoperative in-hospital stay was less in the laparoscopic group (6 days vs 9 days, p = 0.005). There was no mortality.
Conclusion: Laparoscopic left lateral segmentectomy is safe and feasible. Laparoscopic patients may benefit from requiring less postoperative opiate analgesia and a shorter post-operative in-hospital stay.
Background
Laparoscopic liver surgery, first performed in 1992, is becoming the method of choice as surgical expertise in advanced laparoscopic techniques has developed. Laparoscopic enthusiasts have shown that it is safe and feasible to perform laparoscopic liver surgery. Due to its anatomical accessibility left lateral segmentectomy (LLS) has been considered the training operation for all liver surgeons.
Proposed benefits of laparoscopic liver surgery include reduced overall blood loss, shorter hospital stay and less post-operative pain with a faster return to normal activity. But there are concerns as reported complications have included compromised oncological integrity, uncontrollable bleeding and gas emboli.
To date one study has compared laparoscopic left lateral segmentectomy with an open approach using historical case controls. Findings confirmed that the laparoscopic approach was safe and feasible, yet had significantly longer operating times and no difference in post-operative in-patient stay. The aim of this study was to undertake a contemporaneous comparison between laparoscopic and open left lateral segmentectomies.