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What you should know before starting minimal invasive liver resection: an overview
DETRY, Olivier
2014In Acta Chirurgica Belgica, 114 (3), p. 117
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Keywords :
chirurgie; foie; Tumeur hépatique; laparoscopie; coelioscopie
Abstract :
[en] Laparoscopic liver surgery has evolved over the last 2 decades. Advancements in surgical technology, surgical technique, and postoperative care have aided in lifting barriers to laparoscopic liver resections (LLR). LLR might decrease morbidity and hospitalisation stay compared to open approach, and importantly in liver surgery, may decrease postoperative costal pain. However, in hepatic surgery as in all abdominal procedures, laparoscopic approach is a mean but not a goal. The possibility of LLR should neither modify indications for surgery nor the type of resection. Physiologic modifications induced by CO2 pneumoperitoneum should be known by the surgical and anaesthetic team involved in LLR. Pneumoperitoneum decreases cardiac output, and this decrease could be worsened by the reverse Trendelenburg position and by hepatic hilar clamping. CO2 pneumoperitoneum decreases hepatic blood flow. This is a clear advantage for limiting blood loss during LLR, but this also might increase liver ischemia during Pringle liver hilum clamping, a manoeuvre that should be avoided in LLR. Low venous pressure might decrease blood loss by the small supra hepatic veins, but may also further decrease cardiac output. Several devices may be used for liver section, without evidence of the superiority of one device compared to others. Endo GIA might be very helpful to control the major liver vessels, as branches of portal vein or suprahepatic veins. Significant CO2 embolism is a rare complication, and conversion to open approach for haemorrhage should be performed only if blood loss is controlled. Up to now, there is no clear scientific evidence that laparoscopic approach provides any advantage compared to open approach. SILS, LESS or even robotic approaches should only considered as purely experimental. Current barriers to LLR will continue to fall in the future.
Disciplines :
Surgery
Author, co-author :
DETRY, Olivier  ;  Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
Language :
English
Title :
What you should know before starting minimal invasive liver resection: an overview
Publication date :
May 2014
Event name :
Fifteenth Belgian Surgical Week
Event organizer :
Royal Belgian Society for Surgery
Event place :
Spa, Belgium
Event date :
du 14 au 17 mai 2014
By request :
Yes
Journal title :
Acta Chirurgica Belgica
ISSN :
1784-3421
eISSN :
2577-0160
Publisher :
Acta Medica Belgica, Bruxelles, Belgium
Volume :
114
Issue :
3
Pages :
117
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 17 May 2014

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