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Bleeding and hemostasis in laparoscopic liver surgery

Bleeding and hemostasis in laparoscopic liver surgery
Bleeding and hemostasis in laparoscopic liver surgery
Background: minimally invasive liver resection is gaining acceptance worldwide. However, the laparoscopic approach often is reserved for small segmental resections due to the fear of significant blood loss. The expansion of laparoscopic liver surgery will depend on the ability of expert surgeons and technological advances to address the management of bleeding and hemostasis with any new approach. The 4½- year experience of a single center performing totally laparoscopic liver resections is presented, with special reference to the techniques the authors have developed to limit blood loss.

Methods: between 2003 and 2007, 80 patients underwent laparoscopic liver surgery for benign and malignant conditions including colorectal cancer metastases (n = 31), hepatocellular carcinoma (n = 6), neuroendocrine tumor (n = 3), cystic lesion (n = 10), adenoma (n = 8), and focal nodular hyperplasia (n = 7). Totally laparoscopic resections included sectionectomy (n = 27), hemihepatectomy (n = 10), and single/multiple segmentectomies (n = 21). Data for all resections were recorded and analyzed retrospectively to assess blood loss, hospital stay, and morbidity.

Results: the median operative time was 150 min, and the median blood loss was 120 ml, with significantly more blood loss for right-sided transections than for the left liver surgery (821 vs 147 ml; p = 0.012). Four (57%) of seven resections converted to open procedures because of bleeding. No deaths occurred, and only two patients required intraoperative blood transfusions. There were eight complications and one bile leak. The median length of hospital stay was 3 days.

Conclusions: the authors’ experience with 80 totally laparoscopic liver resections over a 4½-year period demonstrates that laparoscopic liver surgery is safe and effective in experienced hands for major resections. An intimate knowledge of the technology and techniques available for preventing and managing significant hemorrhage during laparoscopic liver resection is required for all surgeons performing laparoscopic liver surgery
bleeding, hemostasis, laparoscopic, liver surgery
0930-2794
572-577
Abu Hilal, Mohammad
384e1c60-8519-4eed-8e92-91775aad4c47
Underwood, Tim
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
Taylor, Matthew G.
1978fa0d-36ff-41e4-929f-d21eba8c1bf4
Hamdan, Khaled
8dfd0752-819e-4e94-a0c4-db619d9513b7
Elberm, Hassan
179e1b44-cd08-4853-8479-c73d7b3a3608
Pearce, Neil W.
6e450393-03db-472b-9231-1aa2e39b0565
Abu Hilal, Mohammad
384e1c60-8519-4eed-8e92-91775aad4c47
Underwood, Tim
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
Taylor, Matthew G.
1978fa0d-36ff-41e4-929f-d21eba8c1bf4
Hamdan, Khaled
8dfd0752-819e-4e94-a0c4-db619d9513b7
Elberm, Hassan
179e1b44-cd08-4853-8479-c73d7b3a3608
Pearce, Neil W.
6e450393-03db-472b-9231-1aa2e39b0565

Abu Hilal, Mohammad, Underwood, Tim, Taylor, Matthew G., Hamdan, Khaled, Elberm, Hassan and Pearce, Neil W. (2010) Bleeding and hemostasis in laparoscopic liver surgery. Surgical Endoscopy, 24 (3), 572-577. (doi:10.1007/s00464-009-0597-x).

Record type: Article

Abstract

Background: minimally invasive liver resection is gaining acceptance worldwide. However, the laparoscopic approach often is reserved for small segmental resections due to the fear of significant blood loss. The expansion of laparoscopic liver surgery will depend on the ability of expert surgeons and technological advances to address the management of bleeding and hemostasis with any new approach. The 4½- year experience of a single center performing totally laparoscopic liver resections is presented, with special reference to the techniques the authors have developed to limit blood loss.

Methods: between 2003 and 2007, 80 patients underwent laparoscopic liver surgery for benign and malignant conditions including colorectal cancer metastases (n = 31), hepatocellular carcinoma (n = 6), neuroendocrine tumor (n = 3), cystic lesion (n = 10), adenoma (n = 8), and focal nodular hyperplasia (n = 7). Totally laparoscopic resections included sectionectomy (n = 27), hemihepatectomy (n = 10), and single/multiple segmentectomies (n = 21). Data for all resections were recorded and analyzed retrospectively to assess blood loss, hospital stay, and morbidity.

Results: the median operative time was 150 min, and the median blood loss was 120 ml, with significantly more blood loss for right-sided transections than for the left liver surgery (821 vs 147 ml; p = 0.012). Four (57%) of seven resections converted to open procedures because of bleeding. No deaths occurred, and only two patients required intraoperative blood transfusions. There were eight complications and one bile leak. The median length of hospital stay was 3 days.

Conclusions: the authors’ experience with 80 totally laparoscopic liver resections over a 4½-year period demonstrates that laparoscopic liver surgery is safe and effective in experienced hands for major resections. An intimate knowledge of the technology and techniques available for preventing and managing significant hemorrhage during laparoscopic liver resection is required for all surgeons performing laparoscopic liver surgery

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More information

Published date: March 2010
Keywords: bleeding, hemostasis, laparoscopic, liver surgery

Identifiers

Local EPrints ID: 79405
URI: http://eprints.soton.ac.uk/id/eprint/79405
ISSN: 0930-2794
PURE UUID: cf5844fd-8659-430b-8bf5-373ad218bfc5
ORCID for Tim Underwood: ORCID iD orcid.org/0000-0001-9455-2188

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Date deposited: 15 Mar 2010
Last modified: 14 Mar 2024 02:48

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Contributors

Author: Mohammad Abu Hilal
Author: Tim Underwood ORCID iD
Author: Matthew G. Taylor
Author: Khaled Hamdan
Author: Hassan Elberm
Author: Neil W. Pearce

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