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Laparoscopic Major Hepatectomy: A Systematic Literature Review and Comparison of 3 Techniques

Lin, Niang-Cheng MD; Nitta, Hiroyuki MD; Wakabayashi, Go MD, PhD, FACS

doi: 10.1097/SLA.0b013e31827da7fe

Objective: This review assesses the current status of laparoscopic liver resection.

Background: The trend in laparoscopic liver resection has been moving from limited resections toward major hepatectomy. The surgical techniques for laparoscopic major hepatectomy include pure laparoscopic, hand-assisted laparoscopic, and laparoscopy-assisted methods. We performed a literature search and systematic review to assess the current status of laparoscopic major hepatectomy.

Methods: Our literature review was conducted in Medline using the keywords “laparoscopy” or “laparoscopic” combined with “liver resection” or “hepatectomy.” Articles written in English containing more than 10 cases of laparoscopic major hepatectomy were selected.

Results and Conclusions: Twenty-nine articles were selected for this review. The laparoscopic major hepatectomies achieved similar patient and economic outcomes compared with open liver resections in selected (noncirrhotic) patients. Surgeon experience with the techniques affected the results; thus, a learning period is mandatory. Of these 3 techniques, the pure laparoscopic method is suitable for experienced surgeons to achieve better cosmetic outcomes, whereas the hand-assisted laparoscopic method was associated with better perioperative outcomes; the laparoscopy-assisted method is used by surgeons for unique resections such as resection of cirrhotic livers, laparoscopic resection of tumors in unfavorable locations, and living donor hepatectomies. In addition, the laparoscopic major hepatectomy-specific, long-term oncologic outcomes remain to be addressed in future publications.

We conducted a systemic literature review to identify the current status of laparoscopic major hepatectomy by 3 different surgical techniques.

Department of Surgery, Iwate Medical University School of Medicine, Uchimaru, Morioka, Iwate, Japan.

Reprints: Go Wakabayashi, MD, Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan. E-mail:

Research for this paper was done when N.-C.L. was a clinical fellow with the Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan. N.-C.L. is currently at the Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan.

Disclosure: The authors declare no conflicts of interest.

© 2013 Lippincott Williams & Wilkins, Inc.