American Surgical Association
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Evaluation of 300 Minimally Invasive Liver Resections (MILR) At A Single Institution - Less Is More
Alan J Koffron*, Greg Auffenberg*, Robert Kung*, Michael Abecassis
Northwestern University Feinberg School of Medicine, Chicago, IL

OBJECTIVE(S): To review and evaluate the emerging and evolving experience with laparoscopic liver resection techniques at our center.
METHODS: We present the largest, most comprehensive, single center experience to-date of MILR (July 2001-November 2006) for both benign and malignant conditions.
RESULTS: 241 laparoscopic, 32 hand-assisted laparoscopic and 27 laparoscopy-assisted resections were compared to 100 contemporaneous, cohort-matched open resections. MILR types included segmental (110), bi-segmental (63), left lobe (47), right lobe (64), extended right lobe - trisegmentectomy (8), and caudate (8) resections. Benign etiologies encompassed cysts (70), hemangiomata (37), FNH (23), Adenomata (47) and 20 live donor right lobectomies. Malignant etiologies included primary (43) and metastatic (60) tumors. Hepatic fibrosis/cirrhosis was present in 25/ 103 patients (24%). There was high data consistency within the 3 types of MILR. MILR compared favorably with standard open techniques: operative times (99 vs 182 minutes), blood loss (102 vs 325 milliliters), transfusion requirement (2/300 vs 8/100), length of stay (1.9 vs 5.4 days), overall operative complications (9.3 vs 22%), and local malignancy recurrence (2% vs 3%). No port-site recurrences occurred. Conversion from laparoscopic to hand-assisted laparoscopic resection occurred in 20 patients (6%), with no conversions to open. No hand-assisted procedures were converted to open, but 2 laparoscopy-assisted (7%) were converted to open.
CONCLUSIONS: Our experience demonstrates that 1) MILR of varying magnitudes is safe and effective for both benign and malignant conditions, and 2) MILR outcomes compare favorably with those of the open standard technique. The evolving technical aspects of these procedures will be discussed.

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