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Lessons From an Initial Experience

Yuman Fong, MD; William Jarnagin, MD; Kevin C. Conlon, MD; Ronald DeMatteo, MD; Ellie Dougherty, RN; Leslie H. Blumgart, MD

Arch Surg. 2000;135:854-859.

Background  Recent innovations in laparoscopic instrumentation make routine resection of solid organs a clinical possibility.

Hypothesis  Hand-assisted laparoscopic liver resection is a safe and feasible procedure for solitary cancers requiring removal of 2 segments of liver or less.

Design and Patients  Eleven patients with liver tumors deemed technically resectable by laparoscopic techniques were subjected to laparoscopic evaluation and attempted hand-assisted laparoscopic resection between July 1998 and July 1999. During the same period, 230 patients underwent open liver resection.

Setting  Tertiary care referral center for liver cancer.

Main Outcome Measures  Success of laparoscopic resection, reasons for conversion to open liver resection, blood loss, tumor clearance margin, complications, and length of hospital stay.

Results  Five patients underwent successful resection by the hand-assisted laparoscopic technique. Data from the 5 successful cases and the 6 aborted cases are presented to outline the issues and the lessons learned.

Conclusions  In selected patients, hand-assisted laparoscopic liver resection can be safely performed and might have potential advantages over traditional liver resection if the tumor is limited to the left lateral segment or is at the margins of the liver.

From the Hepatobiliary Service (Drs Fong, Jarnagin, DeMatteo, and Blumgart) and the Department of Surgery (Drs Fong, Jarnagin, Conlon, DeMatteo, and Blumgart and Ms Dougherty), Memorial Sloan-Kettering Cancer Center, New York, NY.

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