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Evolution of laparoscopic left lateral sectionectomy without the Pringle maneuver: through resection of benign and malignant tumors to living liver donation

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Abstract
Laparoscopic left lateral sectionectomy (LLS) has gained popularity in its use for benign and malignant tumors. This report describes the evolution of the authors' experience using laparoscopic LLS for different indications including living liver donation. Between January 2004 and January 2009, 37 consecutive patients underwent laparoscopic LLS for benign, primary, and metastatic liver diseases, and for one case of living liver donation. Resection of malignant tumors was indicated for 19 (51%) of the 37 patients. All but three patients (deceased due to metastatic cancer disease) are alive and well after a median follow-up period of 20 months (range, 8-46 months). Liver cell adenomas (72%) were the main indication among benign tumors, and colorectal liver metastases (84%) were the first indication of malignancy. One case of live liver donation was performed. Whereas 16 patients (43%) had undergone a previous abdominal surgery, 3 patients (8%) had LLS combined with bowel resection. The median operation time was of 195 min (range, 115-300 min), and the median blood loss was of 50 ml (range, 0-500 ml). Mild to severe steatosis was noted in 7 patients (19%) and aspecific portal inflammation in 11 patients (30%). A median free margin of 5 mm (range, 5-27 mm) was achieved for all cancer patients. The overall recurrence rate for colorectal liver metastases was of 44% (7 patients), but none recurred at the surgical margin. No conversion to laparotomy was recorded, and the overall morbidity rate was 8.1% (1 grade 1 and 2 grade 2 complications). The median hospital stay was 6 days (range, 2-10 days). Laparoscopic LLS without portal clamping can be performed safely for cases of benign and malignant liver disease with minimal blood loss and overall morbidity, free resection margins, and a favorable outcome. As the ultimate step of the learning curve, laparoscopic LLS could be routinely proposed, potentially increasing the donor pool for living-related liver transplantation.
Keywords
EXPERIENCE, SURGERY, TRANSPLANTATION, HEPATIC RESECTION, HEPATOCELLULAR-CARCINOMA, FEASIBILITY, OXALIPLATIN, LOBECTOMY, Laparoscopic liver surgery, Left lateral sectionectomy, Living liver donors, Pringle maneuver, Repeat hepatectomy

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Chicago
Troisi, Roberto, Jacques Van Huysse, Frederik Berrevoet, Bert Vandenbossche, MAURICIO SAINZ-BARRIGA, Alessio Vinci, Salvatore Ricciardi, Tommaso Bocchetti, Xavier Rogiers, and Bernard de Hemptinne. 2011. “Evolution of Laparoscopic Left Lateral Sectionectomy Without the Pringle Maneuver: Through Resection of Benign and Malignant Tumors to Living Liver Donation.” Surgical Endoscopy and Other Interventional Techniques 25 (1): 79–87.
APA
Troisi, R., Van Huysse, J., Berrevoet, F., Vandenbossche, B., SAINZ-BARRIGA, M., Vinci, A., Ricciardi, S., et al. (2011). Evolution of laparoscopic left lateral sectionectomy without the Pringle maneuver: through resection of benign and malignant tumors to living liver donation. SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 25(1), 79–87.
Vancouver
1.
Troisi R, Van Huysse J, Berrevoet F, Vandenbossche B, SAINZ-BARRIGA M, Vinci A, et al. Evolution of laparoscopic left lateral sectionectomy without the Pringle maneuver: through resection of benign and malignant tumors to living liver donation. SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES. 2011;25(1):79–87.
MLA
Troisi, Roberto, Jacques Van Huysse, Frederik Berrevoet, et al. “Evolution of Laparoscopic Left Lateral Sectionectomy Without the Pringle Maneuver: Through Resection of Benign and Malignant Tumors to Living Liver Donation.” SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 25.1 (2011): 79–87. Print.
@article{1854994,
  abstract     = {Laparoscopic left lateral sectionectomy (LLS) has gained popularity in its use for benign and malignant tumors. This report describes the evolution of the authors' experience using laparoscopic LLS for different indications including living liver donation. Between January 2004 and January 2009, 37 consecutive patients underwent laparoscopic LLS for benign, primary, and metastatic liver diseases, and for one case of living liver donation. Resection of malignant tumors was indicated for 19 (51%) of the 37 patients. All but three patients (deceased due to metastatic cancer disease) are alive and well after a median follow-up period of 20 months (range, 8-46 months). Liver cell adenomas (72%) were the main indication among benign tumors, and colorectal liver metastases (84%) were the first indication of malignancy. One case of live liver donation was performed. Whereas 16 patients (43%) had undergone a previous abdominal surgery, 3 patients (8%) had LLS combined with bowel resection. The median operation time was of 195 min (range, 115-300 min), and the median blood loss was of 50 ml (range, 0-500 ml). Mild to severe steatosis was noted in 7 patients (19%) and aspecific portal inflammation in 11 patients (30%). A median free margin of 5 mm (range, 5-27 mm) was achieved for all cancer patients. The overall recurrence rate for colorectal liver metastases was of 44% (7 patients), but none recurred at the surgical margin. No conversion to laparotomy was recorded, and the overall morbidity rate was 8.1% (1 grade 1 and 2 grade 2 complications). The median hospital stay was 6 days (range, 2-10 days). Laparoscopic LLS without portal clamping can be performed safely for cases of benign and malignant liver disease with minimal blood loss and overall morbidity, free resection margins, and a favorable outcome. As the ultimate step of the learning curve, laparoscopic LLS could be routinely proposed, potentially increasing the donor pool for living-related liver transplantation.},
  author       = {Troisi, Roberto and Van Huysse, Jacques and Berrevoet, Frederik and Vandenbossche, Bert and SAINZ-BARRIGA, MAURICIO and Vinci, Alessio and Ricciardi, Salvatore and Bocchetti, Tommaso and Rogiers, Xavier and de Hemptinne, Bernard},
  issn         = {0930-2794},
  journal      = {SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES},
  keywords     = {EXPERIENCE,SURGERY,TRANSPLANTATION,HEPATIC RESECTION,HEPATOCELLULAR-CARCINOMA,FEASIBILITY,OXALIPLATIN,LOBECTOMY,Laparoscopic liver surgery,Left lateral sectionectomy,Living liver donors,Pringle maneuver,Repeat hepatectomy},
  language     = {eng},
  number       = {1},
  pages        = {79--87},
  title        = {Evolution of laparoscopic left lateral sectionectomy without the Pringle maneuver: through resection of benign and malignant tumors to living liver donation},
  url          = {http://dx.doi.org/10.1007/s00464-010-1133-8},
  volume       = {25},
  year         = {2011},
}

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