UPDATED TOPICS IN MINIMALLY INVASIVE ABDOMINAL SURGERY

Laparoscopic Liver Surgery
specialist who removes the primary in one sitting. Up to 25% of patients may present in this
way 32. Nonetheless there are no significant publications with any reasonable numbers to draw
on any useful conclusions as to whether there is any benefit with combined laparoscopic
procedures 33 34. Minimally invasive techniques have obvious advantages over two major
laparotomies in a short space of time. With advances in chemotherapy more patients are now
becoming operable with their primary still in situ as there liver disease can be controlled. This
cohort is becoming increasingly more common and challenging 35 36. Generally these patients
have either laparoscopic right hemicoloectomy or laparoscopic anterior resection with excision
of either a solitary or unilobar metastasis. A further group includes those patients who have
major colonic resection with clearing of a single lobe and then further downstaging
chemotherapy prior to definitive resection by a second open liver resection. Recent reports
have suggested no significant differences in post-operative morbidity or mortality or 5 year
survival rates in those patients with synchronous disease who need a minor hepatectomy with
colonic resection 37 38 . In patients who require a major hepatectomy, a test of time, to enable an
assessment of the biological behaviour of the disease and to provide adjuvant treatment, is still
sensible. Although simultaneous laparoscopic major liver resection e.g. right hepatectomy
along with major colonic resection e.g. anterior resection have been successfully described 39 40
the authors would not recommend this without a careful assessment of the patients fitness
because of the need for prolonged anaesthesia beyond 5 hours.
Fig. 3. Colorectal metastasis with the primary colonic tumour still in situ ideal for
simultaneous laparoscopic
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