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Laparoscopic liver resection: Current role and limitations

机译:腹腔镜肝切除术的当前作用和局限性

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摘要

Laparoscopic liver resection (LLR) for the treatment of benign and malignant liver lesions is often performed at specialized centers. Technological advances, such as laparoscopic ultrasonography and electrosurgical tools, have afforded surgeons simultaneous improvements in surgical technique. The utilization of minimally invasive techniques for liver resection has been reported to reduce operative time, decrease blood loss, and shorten length of hospital stay with equivalent postoperative mortality and morbidity rates compared to open liver resection (OLR). Non-anatomic liver resection and left lateral sectionectomy are now routinely performed laparoscopically at many institutions. Furthermore, major hepatic resections are performed by pure laparoscopy, hand-assisted technique, and the hybrid method. In addition, robotic surgery and single port surgery are revealing early promising results. The consensus recommendation for the treatment of benign liver disease and malignant lesions remains unchanged when considering a laparoscopic approach, except when comorbidities and anatomic limitations of the liver lesion preclude this technique. Disease free and survival rates after LLR for hepatocellular carcinoma and metastatic colon cancer correspond to OLR. Patient selection is a significant factor for these favorable outcomes. The limitations include LLR of superior and posterior liver lesions; however, adjustments in technique may now consider a laparoscopic approach as a viable option. As growing data continue to reveal the feasibility and efficacy of laparoscopic liver surgery, this skill is increasingly being adopted by hepatobiliary surgeons. Although the full scope of laparoscopic liver surgery remains infrequently used by many general surgeons, this technique will become a standard in the treatment of liver diseases as studies continue to show favorable outcomes.
机译:腹腔镜肝切除术(LLR)通常在专门的中心进行,以治疗良性和恶性肝病。诸如腹腔镜超声检查和电外科工具等技术进步为外科医生提供了手术技术的同时改进。与开腹肝切除术(OLR)相比,已经报道了采用微创技术进行肝切除术可减少手术时间,减少失血量并缩短住院时间,并具有同等的术后死亡率和发病率。现在,许多机构通常通过腹腔镜进行非解剖学肝切除和左侧外侧切除术。此外,主要的肝切除术是通过纯腹腔镜,手辅助技术和混合方法进行的。此外,机器人手术和单孔手术正在揭示早期有希望的结果。当考虑使用腹腔镜手术时,关于良性肝病和恶性病变的共识性建议保持不变,除非合并肝病的合并症和解剖学限制使该技术无效。 LLR后肝细胞癌和转移性结肠癌的无病生存率与OLR相对应。患者选择是获得这些有利结果的重要因素。局限性包括上,后肝病变的LLR;但是,现在技术上的调整可能会将腹腔镜方法视为可行的选择。随着越来越多的数据继续显示腹腔镜肝脏手术的可行性和有效性,肝胆外科医师越来越多地采用这种技能。尽管许多普通外科医师仍很少使用腹腔镜肝脏外科手术的全部范围,但随着研究继续显示出良好的结果,该技术将成为治疗肝脏疾病的标准。

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