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Dr. Francesco Lattanzio received his medical degree from the University of Bari (Italy). He completed his general surgery residency at the University of Trieste (Italy). During his training he was at C.H.U. Toulouse (France) with Pr. Gilles Fourtanier, secretary of the Societé Francaise de Chirurgie Endoscopique, at C.H.U. Jean Verdier (Assistance Publique Hopitaux de Paris) with Pr. Gerard Champault, President of the Societé Francaise de Chirurgie Laparoscopique, at C.H.U. Avicenne (Assistance Publique Hopitaux de Paris) with Pr. Jacques Azorin, past President of Societé Francaise de Chirurgie Thoracique et Cardiovasculaire and with Pr. Luis Perez-Ruiz at Lleida University in Catalunya (Spain). He is certified in “Chirurgie Hèpatobiliaire” at University Paris Sud with Pr. Denis Castaing. Dr. Lattanzio is associated with the development of many advanced laparoscopic operations including colorectal cancer, small bowel obstruction, and incisional hernia repair. He currently works at Dimiccoli Hospital in Barletta (Italy).
Laparoscopic liver resections (LLR) represent the new frontier of liver surgery. During the last decade indications for the laparoscopic approach to the liver have been widely extended, from peripheral benign lesions to malignant neoplasms, difficult localizations and major resections.
Laparoscopic liver surgery was slower to develop than other fields of laparoscopic surgery because of a steep learning curve, and fear of uncontrolled bleeding or gas embolism. However, LLR is associated with significant advantages of laparoscopic procedures. The aim of this retrospective study is to evaluate the extent and safety of the learning curve for LLR.
We retrospectively analyzed 87 patients who underwent a LLR from July 2010 to November 2017 performed by a single senior surgeon. At the start of experience the indication was a single lesion, whereas in the last years an increasing number of patients was enrolled for laparoscopic intervention, according to the learning curve.
Diseases included liver cancer, hepatic hemangioma, focal nodular hyperplasia, liver abscess, and metastatic liver cancer. The diagnosis was a malignant neoplasm for 53 patients (61%), a benign lesion for the remaining cases.
In 45 patients a synchronous procedure was performed (4 right colectomy, 6 left colectomy, 8 rectal resection, 2 gastric resection, 21 cholecistectomy, 4 for other procedures) .
35 patients were males and 42 were females, with a mean age of 60 years (range 23-88). 81 patients (93%) had a good preoperatory hepatic function, assessed with A Child-Pugh score.
We performed 63 wedge resections (72%), 2 segmentectomies, 4 right lateral bisegmentectomies, 13 left lobectomies (15%), 4 left hepatectomies and 1 robotic right hepatectomy, the latter converted for intraoperatory bleeding. Median operative time was 120 minutes (35-330). There were no intraoperative or postoperative deaths and 26% of morbidity (ascites in 7 patients, fever in 7 patients, pneumonia in 4 patients, 1 needed blood transfusion and 3 surgery-related complications occurred). Only one major complication (grade III of Clavien-Dindo classification) was observed, in a patient who received a synchronous proctectomy and needed reoperation for anastomotic dehiscence. The median time of discharge was 5 days (range 2-11). A negative histological margin (R0) was obtained in 88% of malignancy cases.
In our experience laparoscopic surgery is a safe option for hepatic resection in benign such as malignant lesions, good patient selection and refined surgical technique are the keys to successful of LLR, especially at the beginning of the learning curve as well as the experience of the surgeon in advanced laparoscopic procedures and hepatobiliary surgery.