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Francesco Ardito, MD; Claude Tayar, MD; Alexis Laurent, MD, PhD; Mehdi Karoui, MD, PhD; Jerome Loriau, MD; Daniel Cherqui, MD

Arch Surg. 2007;142(12):1188-1193.

Hypothesis  Resection for benign liver disease can represent a valid indication for the laparoscopic approach.

Design  Prospective case series.

Setting  Tertiary referral center.

Patients  Fifty patients with benign disease underwent laparoscopic liver resection. Indications for resection included preoperative diagnosis of adenoma or cystadenoma, uncertain preoperative diagnosis, and presence of symptoms. Inclusion criteria were lesions 5 cm or less located in the peripheral segments (segments 2-6).

Intervention  Laparoscopic liver resection using a surgical technique including 5 ports, harmonic transection, stapling of large vessels, and extraction in a bag through a separate incision.

Main Outcome Measures  Intraoperative results and postoperative morbidity.

Results  Thirty-five patients (70%) presented with solid tumor; 11 (22%), with cystic lesions; and 4 (8%), with biliary disease. Tumor was solitary in 41 cases (82%) and multiple in 9 (18%). Mean (SD) surgical time was 191 (77.5) minutes (range, 30-480 minutes). There were 4 conversions (8%) and 1 patient received a transfusion (2%). There was no mortality. The postoperative morbidity rate was 10% and included only nonspecific complications. Median hospital stay was 5 days.

Conclusions  Laparoscopic liver resection for benign disease can be recommended in patients with peripheral lesions requiring limited resection. Major resections may be performed in highly select patients but require further evaluation. Specific training is required. Indications for laparoscopic resection of benign liver disease must be the same as those for open surgery. Reduction of abdominal wall damage and cosmetic advantages of the laparoscopic approach represent a clear benefit in patients with benign liver disease.

Author Affiliations: Department of Digestive Surgery, Assistance Publique–Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Créteil, France.

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Laparoscopic Liver Resection for Benign Disease—Invited Critique
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Arch Surg. 2007;142(12):1193.
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