- 期刊
Laparoscopic Liver Dissection Technique and Control of Bleeding for Hepatocellular Carcinoma
摘要
Laparoscopic liver resection (LLR) was first reported by Reich in USA in 1991 and by Kaneko in Japan in 1993. Author personally started to perform LLR for HCC in 1998. Since the first and second International Consensus Conferences on Laparoscopic Liver Resection in 2008 and 2014, the trend of using LLR is clear and has advantages in terms of less blood loss and less complication. Laparoscopic techniques for liver resection were classified into pure laparoscopic liver resection, hand-assisted liver resection, and hybrid technique liver resection. The choice of method will depend on the tumor location and the difficulty of transection. There were several instruments for liver parenchyma dissection depending on the surgeon's experience and preference. There were 32 studies of HCC ＞ 15 patients from each report and enrolled in this review. Totally, there were 2,511 patients of HCC, and their mean operative time was 235 minutes (ranged 140-420 minutes) and mean blood loss was 275.2 mL (ranged 55-630 mL). In addition, LLR had a better results compared with open liver resection. However, robotic approach for LLR had a similar blood loss but significantly longer operative time in the HCC patients compared with the conventional laparoscopic approach. In conclusion, laparoscopic liver resection is a procedure with significant risk and technical demand. The suggestion is for surgeons with limited experience in LLR should begin with wedge resection or minor liver resection, and then, transition to major hepatectomy with the hybrid procedures.