Top

Published in:

01-06-2015 | Review Article

Italian experience in minimally invasive liver surgery: a national survey

Authors: Luca Aldrighetti, Giulio Belli, Luigi Boni, Umberto Cillo, Giuseppe Ettorre, Luciano De Carlis, Antonio Pinna, Luciano Casciola, Fulvio Calise, Italian Group of Minimally Invasive Liver Surgery (I GO MILS)

Published in: Updates in Surgery | Issue 2/2015

Abstract

This survey provides an overview about current spread of Minimally Invasive Liver Resection (MILR) in Italy. Primary endpoint was to assess evolution of MILR in recent years and its degree of application among centres with different experience in laparoscopic and hepatic surgery. A questionnaire with items describing activity MILR was sent to Italian surgical centers. Diagnosis, technical approaches, resection extent, devices and vascular control, reasons for conversion, morbidity and mortality were recorded. Level of expertise per centre was analysed in terms of learning curve acquisition and relationship with hepatobiliary background. 1497 MILRs from 39 centers (median 27 patients/center, range 1–145, period 1995–2012) were collected. Conversion rate was 10.7 % (180 patients out of 1677, excluded from subsequent analysis), with bleeding representing most frequent cause of conversion (34.4 %). Eleven centers completed learning curve, performing >60 MILR. Benign lesions were 27.5 % and malignant 72.5 %, with hepatocellular carcinoma being the most frequent indication. 92.6 % of cases were performed with a totally laparoscopic technique (1.3 % were hand-assisted, 1.9 % single-port and 4.2 % robotic). Minor resections accounted for 92.9 % (left lateral sectionectomy resulted the most frequent procedure; 23.8 %), while major resections represented 7.1 %. Overall mortality was 0.2 % (3 of 1497 patients) and morbidity 22.8 %. Mean length of stay was 5 days. Correlation between MILR activity and a hepatobiliary background was not clear comparing MILR cases and liver resection volumes per center. MILR has been significantly widespread in Italy in recent years, with several centers having definitely completed the learning curve as attested by clinical results consistent with major series from the Western and Eastern countries. MILR programs in Italy seem to arise from both centers with specific hepatobiliary expertise and centers performing advanced general laparoscopic surgery.

Available only for authorised users

Belli G, Fantini C, Belli A, Limongelli P (2011) Laparoscopic liver resection for hepatocellular carcinoma in cirrhosis: long-term outcomes. Dig Surg 28:134–140PubMedCrossRef

Nguyen KT, Laurent A, Dagher I, Geller DA, Steel J, Thomas MT, Marvin M, Ravindra KV, Mejia A, Lainas P, Franco D, Cherqui D, Buell JF, Gamblin TC (2009) Minimally invasive liver resection for metastatic colorectal cancer: a multi-istitutional, international report of safety, feasibility and early outcomes. Ann Surg 250(5):842–848PubMedCrossRef

Nguyen KT, Gambin TC, Geller DA (2009) World review of laparoscopic liver resection—2804 patients. Ann Surg 250:831–841PubMedCrossRef

Aldrighetti L, Pulitanò C, Catena M, Arru M, Guzzetti E, Casati M, Comotti L, Ferla G (2008) A prospective evaluation of laparoscopic versus open left lateral hepatic sectionectomy. J Gastrointest Surg 12:457–462PubMedCrossRef

Morino M, Morra I, Rosso E, Miglietta C, Garrone C (2003) Laparoscopic vs. open hepatic resection. Surg Endosc 17:1914–1918PubMedCrossRef

Santambrogio R, Aldrighetti L, Barabino M, Pulitanò C, Costa M, Montorsi M, Ferla G, Opocher E (2009) Laparoscopic liver resections for hepatocellular carcinomaIs it a feasible option for patients with liver cirrhosis? Langenbecks Arch Surg 394(2):255–264PubMedCrossRef

Casciola L, Patriti A, Ceccarelli G, Bartoli A, Ceribelli C, Spaziani A (2011) Robot-assisted parenchymal-sparing liver surgery including lesions located in the posterosuperior segments. Surg Endosc 25:3815–3824PubMedCrossRef

Park JS, Han HS, Hwang DW, Yoon YS, Cho JY, Koh YS, Kwon CH, Kim KS, Kim SB, Kim YH, Kim HC, Chu CW, Lee DS, Kim HJ, Park SJ, Han SS, Song TJ, Ahn YJ, Yoo YK, Yu HC, Yoon DS, Lee MK, Lee HK, Min SK, Jeong CY, Hong SC, Choi IS, Hur KY (2012) Current status of laparoscopic liver resection in Korea. J Korean Med 27:767–771CrossRef

Tsuchiya M, Otsuka Y, Tamura A, Nitta H, Sasaki A, Wakabayashi G, Kaneko H (2009) Status of endoscopic liver surgery in Japan: a questionnaire survey conducted by the Japanese Endoscopic Liver Surgery Study Group. J Hepatobiliary Pancreat Surg 16:405–409PubMedCrossRef

10.

Viganò L, Laurent A, Tayar C, Tomatis M, Ponti A, Cherqui D (2009) The learning curve in laparoscopic liver resection. Improved feasibility and reproducibility. Ann Surg 250:772–782PubMedCrossRef

11.

Terminology Committee of the International Hepato-Pancreato-Biliary Association (2000) The IHPBA Brisbane 2000 terminology of liver anatomy and resections. HPB Surg 2:333–339

12.

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196PubMedCrossRef

13.

Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS, World Consensus Conference on Laparoscopic Surgery (2008) The international position on laparoscopic liver surgery: the Louisville statement. Ann Surg 250(5):825–830CrossRef

14.

Nguyen KT, Marsh JW, Tsung A, Steel JJ, Gamblin TC, Geller DA (2011) Comparative benefits of laparoscopic vs open hepatic resection: a critical appraisal. Arch Surg 146:348–356PubMedCrossRef

15.

Chang S, Laurent A, Tayar C, Karoui M, Cherqui D (2007) Laparoscopy as a routine approach for left lateral sectionectomy. Br J Surg 94(1):58–63PubMedCrossRef

16.

Belli G, Fantini C, D’Agostino A, Cioffi L, Langella S, Russolillo N, Belli A (2007) Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results. Surg Endosc 21(11):2004–2011PubMedCrossRef

17.

Laurent A, Cherqui D, Lesurtel M, Brunetti F, Tayar C, Fagniez PL (2003) Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg 138:763–769PubMedCrossRef

18.

Aldrighetti L, Guzzetti E, Pulitanò C, Cipriani F, Catena M, Paganelli M, Ferla G (2010) Case-Matched analysis of totally laparoscopic versus open liver resection for HCC: short and middle term results. J Surg Oncol 102:82–86PubMedCrossRef

19.

Zhou YM, Shao WY, Zhao YF, Xu DH, Li B (2011) Meta-analysis of laparoscopic versus open resection for hepatocellular carcinoma. Dig Dis Sci 56:1937–1943PubMedCrossRef

20.

Farges O, Goutte N, Bendersky N, Falissard B, on behalf of the ACHBT-French Hepatectomy study group (2012) Incidence and risks of liver resections. An all-inclusive French nationwide study. Ann Surg 256:697–705PubMedCrossRef

21.

Azagra JS, Goergen M, Brondello S, Calmes MO, Philippe P, Schmitz B (2009) Laparoscopic liver sectionectomy 2 and 3 (LLS 2 and 3): towards the “gold standard”. J Hepatobiliary Pancreat Surg 16:422–426PubMedCrossRef

22.

Dagher I, O’Rourke N, Geller DA, Cherqui D, Belli G, Gamblin TC, Lainas P, Laurent A, Nguyen KT, Marvin MR, Thomas M, Ravindra K, Fielding G, Franco D, Buell JF (2009) Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg 250:856–860PubMedCrossRef

23.

Torzilli G, Montorsi M, Donadon M, Palmisano A, Del Fabbro D, Gambetti A, Olivari N, Makuuchi M (2005) “Radical but conservative” is the main goal of ultrasonography-guided liver resection: prospective validation of this approach. J Am Coll Surg 201:517–528PubMedCrossRef

24.

Ferrero A, Viganò L, Lo Tesoriere N, Russolillo N, Sgotto E, Capussotti L (2009) Bisegmentectomies as alternative to right hepatectomy in the treatment of colorectal liver metastases. Hepatogastroenterology 56:1429–1435PubMed

25.

Huang MT, Wei PL, Wang W, Li CJ, Lee YC, Wu CH (2009) A series of laparoscopic liver resections with and without HALS in patients with hepatic tumors. J Gastrointest Surg 13(5):896–906PubMedCrossRef

26.

Aldrighetti L, Ratti F, Catena M, Pulitanò C, Cipriani F, Ferla G (2012) Laparoendoscopic single site (LESS) surgery for left-lateral hepatic sectionectomy as an alternative to traditional laparoscopy: case-matched analysis from a single center. Surg Endosc 26(7):2016–2022PubMedCrossRef

27.

Giulianotti PC, Sbrana F, Bianco FM, Addeo P (2010) Robot-assisted laparoscopic extended right hepatectomy with biliary reconstruction. J Laparoendosc Adv Surg Tech A 220:159–163CrossRef

28.

Gurusamy KS, Samraj K, Davidson BR (2007) Routine abdominal drainage for uncomplicated liver resection. Cochrane Database Syst Rev 3:CD006232PubMed

29.

van Dam RM, Wong-Lun-Hing EM, van Breukelen GJ, Stoot JH, van der Vorst JR, Bemelmans MH, Olde Damink SW, Lassen K, Dejong CH (2012) Open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery ERAS^® programme (ORANGE II-trial): study protocol for a randomised controlled trial. Trials 13:54PubMedCentralPubMedCrossRef

Title: Italian experience in minimally invasive liver surgery: a national survey
Authors: Luca Aldrighetti
Giulio Belli
Luigi Boni
Umberto Cillo
Giuseppe Ettorre
Luciano De Carlis
Antonio Pinna
Luciano Casciola
Fulvio Calise
Italian Group of Minimally Invasive Liver Surgery (I GO MILS)
Publication date: 01-06-2015
Publisher: Springer Milan
Published in: Updates in Surgery / Issue 2/2015
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-015-0307-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Italian experience in minimally invasive liver surgery: a national survey

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2015

Segmentectomy: is minimally invasive surgery going to change a liver dogma?

The difficulty of laparoscopic liver resection

Salvage liver transplantation after laparoscopic resection for hepatocellular carcinoma: a multicenter experience

Laparoscopic surgery of postero-lateral segments: a comparison between transthoracic and abdominal approach

Mils for HCC: the state of art

Total abdominal approach for postero-superior segments (7, 8) in laparoscopic liver surgery: a multicentric experience