• Ricardo Robles, Caridad Marín, Beatriz Abellán, Asunción López, Patricia Pastor, and Pascual Parrilla.
• Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain. rirocam@um.es
• Surg Endosc. 2008 Nov 1; 22 (11): 2357-64.

BackgroundThe best type of laparoscopic approach in solid liver tumours (SLTs), whether total laparoscopic surgery or hand-assisted laparoscopic surgery (HALS), has not yet been established. Our objective is to present our experience with laparoscopic liver resections in SLTs performed by HALS using a new approach.MethodsWe performed 35 laparoscopic resections in SLTs, of which 26 were carried out using HALS (in 25 patients) and 21 patients had liver metastases of a colorectal origin (LMCRC) (1 patient had 2 resections), 1 metastasis from a neuroendocrine tumour of the pancreas, 1 hepatocarcinoma on a healthy liver, 1 primary hepatic leiomyosarcoma and 1 giant haemangioma. Mean follow-up was 22 months. OPERATION: One right hemihepatectomy, one left hemihepatectomy, five bisegmentectomies II-III, three bisegmentectomies VI-VII and 16 segmentectomies (five of S. VI, three of S. VIII; three of S. V; two of S. IVb; one of S. II; one of S. IV; and in the remaining case resection of S. III and VI plus resection of a metastasis in S. VIII).Main Outcome MeasuresMorbidity and mortality, conversion to open procedure, intraoperative blood loss, intra- and postoperative transfusion, length of stay and survival.ResultsThere were no intra- or postoperative deaths, nor were there any conversions. One patient presented with morbidity (3.8%) (liver abscess). Mean blood loss was 200 ml (range 0-600 ml). One patient required transfusion (3.8%). Mean operative time was 180 min (range 120-360 min). Mean length of hospital stay was 4 days (range 2-5 days). The actuarial survival rate of the patients at 36 months with liver metastases from colorectal carcinoma (LMCRC) was 80%.ConclusionsLiver resection with HALS reproduces the low morbidity and mortality rates and effectiveness (3-year survival) of open surgery in SLTs when indicated selectively.

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