C. C. Taylor1, C. Y. Chai1, N. N. Massarweh1, S. S. Awad1, H. S. Tran Cao1 1Baylor College of Medicine,Surgery,Houston, TX, USA
Introduction: Liver surgery has historically been considered technically challenging and poorly suited for minimally invasive approaches. In recent years, both laparoscopy and robotic surgery have been advocated as good, or even preferable, alternative approaches to open liver surgery in certain situations. At the same time, an emphasis on parenchymal preservation has reduced the need for major hepatectomies. The goals of this study were to evaluate our institutional experience with minimally invasive liver surgery.
Methods: This was a retrospective review of our institutional hepatobiliary database. Patients undergoing liver surgery between 2010 and 2016 were included in the study. Surgical approaches were classified as open surgery, laparoscopic (which included hand-assisted laparoscopic), and robotic. Operations included ablation, non-anatomic partial hepatectomies, minor anatomic hepatectomies (fewer than 3 segments), and major hepatectomies (3 or more segments).
Results: During the study period, 101 liver operations for which complete data was available were conducted, of which 44 were performed in a minimally invasive manner. Indications for surgery included hepatocellular carcinoma (85, 84.2%), intrahepatic cholangiocarcinoma (11, 10.9%), metastatic disease (4, 4.0%), and benign pathology (1, 1.0%). All but one patient were male, and mean age was 63.4. All major hepatectomies were performed via an open approach. Of the first 50 cases performed, 24 (48.0%) were done laparoscopically. Of these, 16 (66.7%) consisted of ablations, 2 (8.3%) of non-anatomic hepatectomies, and 5 (20.8%) of minor hepatectomies – all left lateral sectionectomies. By comparison, of the last 51 cases, 20 (39.2%) were performed in a minimally invasive manner, including 3 robotically. Of the 20 cases, 4 (20%) were ablations, and 15 (75%) were non-anatomic partial or minor hepatectomies. In both groups, one minimally invasive operation was aborted after intraoperative ultrasound found the tumor to have progressed beyond the point of resectability. The most common reason for open surgery in patients whose tumor did not require a major hepatectomy was prior abdominal surgery.
Conclusion: With increasing experience, minimally invasive techniques can be successfully applied to liver surgery, with a clear role for resection rather than simply for ablative purposes. Although no major hepatectomy was performed via minimally invasive approaches during this study period, laparoscopic and robotic approaches to deep or posterior lesions were achievable and safe.