UPDATED TOPICS IN MINIMALLY INVASIVE ABDOMINAL SURGERY

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86 Updated Topics in Minimally Invasive Abdominal Surgery [3] O’Rourke N, Fielding G: Laparoscopic right hepatectomy: surgical technique. J Gastrointest Surg2004; 8: 213-216. [4] Dagher I, Di Giuro G, Lainas P, Franco D: Laparoscopic right hepatectomy with selective vascular exclusion. J Gastrointest Surg2009; 13: 148-149. [5] Han HS, Cho JY, Yoon YS: Techniques for performing laparoscopic liver resection in various hepatic locations. J Hepatobiliary Pancreat Surg2009; 16: 427-432. [6] Gayet B, Cavaliere D, Vibert E, Perniceni T, Levard H, Denet C, Christidis C, Blain A, Mal F: Totally laparoscopic right hepatectomy. Am J Surg2007; 194: 685-689. [7] Takasaki K, Kobayashi S, Tanaka S, Saito A, Yamamoto M, Hanyu F: Highly anatomically systematized hepatic resection with Glissonean sheath code transection at the hepatic hilus. Int Surg1990; 75: 73-77. [8] Takasaki K: Glissonean pedicle transection method for hepatic resection: a new concept of liver segmentation. J Hepatobiliary Pancreat Surg1998; 5: 286-291. [9] Cho A, Yamamoto H, Nagata M, Takiguchi N, Shimada H, Kainuma O, Souda H, Gunji H, Miyazaki A, Ikeda A, Matsumoto I: Safe and feasible inflow occlusion in laparoscopic liver resection. Surg Endosc2009; 23: 906-908. [10] Cho A, Asano T, Yamamoto H, Nagata M, Takiguchi N, Kainuma O, Souda H, Gunji H, Miyazaki A, Nojima H, Ikeda A, Matsumoto I, Ryu M, Makino H, Okazumi S: Laparoscopy-assisted hepatic lobectomy using hilar Glissonean pedicle transection. Surg Endosc2007; 21: 1466-1468. [11] Cho A, Yamamoto H, Kainuma O, Souda H, Ikeda A, Takiguchi N, Nagata M: Safe and feasible extrahepatic Glissonean access in laparoscopic anatomical liver resection. Surg Endosc2011; 25: 1333-1336. [12] Machado MA, Makdissi FF, Galvão FH, Machado MC: Intrahepatic Glissonian approach for laparoscopic right segmental liver resections. Am J Surg 2008; 196: 38- 42. [13] Topal B, Aerts R, Penninckx F: Laparoscopic intrahepatic Glissonian approach for right hepatectomy is safe, simple, and reproducible. Surg Endosc 2007; 21: 2111.
1. Introduction 7 Laparoscopic Liver Surgery Steven A. White, Rajesh Y. Satchidanand and Derek M. Manas Department of Hepatobiliary and Transplant Surgery, The Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, England Recent improvements in cross sectional imaging, chemotherapy and advances in the techniques of liver resection have resulted in rates of 5 year survival approaching 60% for patients with colorectal liver metastasis. Historically liver resection was perceived as a formidable operation but now liver resection is safe and specialist centres should expect low mortality rates in the region of 1-2% 1,2. Consequently, many more patients are now referred for liver resection and its indications are continually being revised and expanded. At the same time there have been many advances in minimally invasive laparoscopic surgical techniques so much so that laparoscopic liver resection (LLR) is becoming an increasingly popular option amongst laparoscopic enthusiasts. Indeed the first laparoscopic liver resection was described nearly 20 years ago for focal nodular hyperplasia 3. In a recent review by Nguyen and colleagues 4,5 over 3,000 laparoscopic liver resections have now been reported in various series and meta-analyses 6 7 8. Despite this enthusiasm doubts still remain over its more widespread application because of the risks of complications and whether there is any patient benefit 9-11. The latter is still very difficult to demonstrate in the absence of any well designed randomized controlled trials. Like laparoscopic cholecystectomy that came before, it is now very unlikely that any well designed Randomised controlled trials (RCT) will ever be performed. Perhaps the most important RCT that should have been done is outcome after laparoscopic left lateral resection versus open resection. Yet for laparoscopic enthusiasts the advantages are so obvious they would now be very reluctant to offer open resection in a trial setting. The situation is very different for major resections e.g. right hepatectomy where any advantage is still very difficult to demonstrate. In this situation a RCT would be difficult to design as few centres regularly perform this operation and large numbers would be needed because of high rates of conversion and recruiting patients with tumours distributed in such away that they can be resected laparoscopically. 2. Indications and contra-indications 2.1 International consensus - The Louisville statement In 2008 a consensus meeting was convened in Louisville to discuss the position of LLR amongst some of the worlds leading hepatobiliary surgeons. This was a very important development and the following guidelines were suggested as follows 11: 1. LLR can be performed safely in specialized centres with results comparable to those achieved after open resection
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VI Contents Chapter 9 Appendicitis
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Part 1 Laparoscopic Biliary-Pancrea
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Laparoscopic Hernia Repair defect.
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Laparoscopic Hernia Repair LeBlanc,
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Laparoscopic Approach to Abdominal
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UPDATED TOPICS IN MINIMALLY INVASIVE ABDOMINAL SURGERY

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