Conventional laparoscopic and robot-assisted laparoscopic liver resection for benign and malignant pathologies: a cohort study.

The aim of our study was to evaluate different minimally invasive surgical approaches for liver resection in a tertiary surgical center. The study cohort comprised 104 consecutive patients who underwent total laparoscopic liver resection (n = 17), hand-assisted laparoscopic liver resection (n = 55), or robot-assisted laparoscopic liver resection (n = 32) in our center between October 1998 and January 2011. Surgical complications, postoperative course, disease-free survival, and overall survival for malignancy were assessed. These 104 resections were performed on 55 men and 49 women with a mean age of 60.4 years; 43.3% of patients had liver cirrhosis. The liver pathologies comprised malignant tumors (64.4%) and benign lesions (35.6%). The most common laparoscopic liver resection was left lateral sectionectomy (53.9%), wedge resection (26.9%), segmentectomy (13.5%), right hepatectomy (3.8%), and left hepatectomy (1.9%). Conversion from laparoscopy to open approach and from laparoscopy to hand-assisted approach occurred in 1.9 and 1% of the cases, respectively. Overall mortality was 0%, and morbidity was 17.3%. The median follow-up period was 24 months. The 5-year overall survival for hepatocellular carcinoma (HCC) was 52%, and the 3-year overall survival for colorectal liver metastasis was 88%. Based on these results, we conclude that laparoscopic liver resection is feasible and safe in appropriately selected patients. In our patient cohort, it was associated with a low complications rate and favorable survival outcome.