BACKGROUND: The 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. METHODS: We 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 MEASURES: Morbidity and mortality, conversion to open procedure, intraoperative blood loss, intra- and postoperative transfusion, length of stay and survival. RESULTS: There 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%. CONCLUSIONS: Liver 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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机译：背景：无论是全腹腔镜手术还是手助腹腔镜手术（HALS），目前尚无在实体肝肿瘤（SLTs）中腹腔镜手术的最佳类型。我们的目标是介绍我们使用新方法在HALS进行的SLT中进行腹腔镜肝切除的经验。方法：我们对35例SLT患者进行了35例腹腔镜切除术，其中26例使用HALS手术（25例），其中21例患有结直肠源性肝转移（LMCRC）（1例患者进行了2例切除），其中1例来自神经内分泌肿瘤胰腺，健康肝脏上的1例肝癌，1例原发性肝平滑肌肉肉瘤和1例大血管瘤。平均随访时间为22个月。手术：一例右半肝切除术，一例左半肝切除术，五例二段切除术II-III，三例二段切除术VI-VII和16节段切除术（S. VI中的五个，S。VIII中的三个; S。V中的三个; S。IVb中的两个; S。IVb中的一个; S. II的切除; S。IV的切除;在其余情况下，S。III和VI的切除加上S. VIII的转移的切除）。主要观察指标：发病率和死亡率，转为开放手术，术中失血，术中和术后输血，住院时间和生存期。结果：无术中或术后死亡，也无任何转换。一名患者发病（3.8％）（肝脓肿）。平均失血量为200毫升（范围为0-600毫升）。一名患者需要输血（3.8％）。平均手术时间为180分钟（范围为120-360分钟）。平均住院时间为4天（范围2-5天）。结直肠癌（LMCRC）肝转移患者在36个月时的精算生存率为80％。结论：选择性选择使用HALS进行肝切除术可以降低SLT患者开放手术的低发病率和死亡率以及有效性（3年生存率）。
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