LESSONS LEARNT FROM THE FIRST 100 LAPAROSCOPIC LIVER RESECTIONS: NOT DELAYING CONVERSION MAY ALLOW REDUCING BLOOD LOSS AND OPERATIVE TIME.

Background The laparoscopic approach to liver resective surgery is slowly diffusing in specialized centers. Little is known about factors influencing the immediate postoperative outcome. Study design The purpose of the study was to evaluate the immediate outcome of laparoscopic liver resection (LLR), with particular emphasis on intraoperative bleeding and conversion. A retrospective analysis of demographic, clinical and surgical data, including conversion, morbidity/mortality and hospital stay, of the first 100 patients undergoing LLR from February 1997 through March 2007 was performed. Results Indication to LLR was benign lesion in 28 patients, malignancy in 33 and living donation in 39. Seventy-five resections involved ≥2 segments. Mean blood loss was 120 ± 127.6 ml. One patient (1%) required transfusion. Mean operative time was 253 ± 91.6 min. Mortality was nil. Postoperative complications occurred in 21 patients. Conversion rate was 17%. Variables related to conversion were: ASA class II, BMI, cirrhosis, necessity of Pringle maneuver, intraoperative blood loss. Conversion did not influence the operative time. Converted patients had more complications and longer hospital stay. Conclusion Liver resection by laparoscopy is feasible and safe, implying low intraoperative blood loss. Not perfect physical conditions, cirrhosis, high BMI and, intraoperatively, blood loss and the necessity of a Pringle maneuver, should be considered risk factors for conversion. A meticulous dissection by bipolar coagulation, harmonic scalpel and ultrasound dissector, other than the attitude not to delay conversion in difficult cases, may allow for low blood loss without prolongation of operative time, with a possible, slight increase of the conversion-rate