Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
Surg Endosc. 2017 Oct;31(10):4150-4155. doi: 10.1007/s00464-017-5468-2. Epub 2017 Mar 31.
Techniques for laparoscopic liver resection (LLR) have been developed over the past two decades. The aim of this study is to analyze the outcomes and trends of LLR.
203 patients underwent LLR between 2006 and 2015. Trends in techniques and outcomes were assessed dividing the experience into 2 periods (before and after 2011).
Tumor type was malignant in 62%, and R0 resection was achieved in 87.7%. Procedures included segmentectomy/wedge resection in 64.5%. Techniques included a purely laparoscopic approach in 59.1% and robotic 12.3%. Conversion to open surgery was necessary in 6.4% cases. Mean hospital stay was 3.7 ± 0.2 days. 90-day mortality was 0% and morbidity 20.2%. Pre-coagulation and the robot were used less often, while the performance of resections for posteriorly located tumors increased in the second versus the first period.
This study confirms the safety and efficacy of LLR, while describing the evolution of a program regarding patient and technical selection. With building experience, the number of resections performed for posteriorly located tumors have increased, with less reliance on pre-coagulation and the robot.
腹腔镜肝切除术 (LLR) 技术在过去二十年中得到了发展。本研究旨在分析 LLR 的结果和趋势。
203 例患者于 2006 年至 2015 年期间接受 LLR。通过将经验分为 2 个时期（2011 年之前和之后）来评估技术和结果的趋势。
肿瘤类型为恶性占 62%，R0 切除率为 87.7%。手术包括节段切除术/楔形切除术占 64.5%。技术包括纯腹腔镜方法占 59.1%和机器人辅助手术占 12.3%。有 6.4%的病例需要转为开腹手术。平均住院时间为 3.7±0.2 天。90 天死亡率为 0%，发病率为 20.2%。术前凝血和机器人辅助手术的使用频率降低，而在第二阶段，后位肿瘤切除术的数量增加。
本研究证实了 LLR 的安全性和有效性，同时描述了患者和技术选择方面的项目演变。随着经验的积累，后位肿瘤的切除术数量增加，对术前凝血和机器人的依赖减少。
