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Page 2 of 11 Pais-Costa et al. Mini-invasive Surg 2018;2:33 I http://dx.doi.org/10.20517/2574-1225.2018.33

Conclusion: LH should be considered the main therapeutic approach for treating selected patients with benign liver
lesions who require surgical resection because it presented both null mortality and low morbidity, along with rare
recurrence, a good quality of life and high esthetic satisfaction.

Keywords: Laparoscopic liver surgery, liver neoplasms, adenoma, liver cell, focal nodular hyperplasia, hemangioma,
cavernous, quality of life

INTRODUCTION
Since the early 90s, when the first laparoscopic anatomical resection of the liver was reported, laparoscopic
[1]
hepatectomy (LH) has gained increasing importance for treating hepatic tumors . Several advances in
laparoscopic instruments such as parenchymal transection devices, staplers and hand-assisted equipment,
together with improved expertise in laparoscopic surgery, have led to increasing use of LH, especially in
referral centers. Given its many advantages over open hepatectomy, including less postoperative pain, less
use of opiate analgesia, better cosmetic results, decreased blood loss, decreased postoperative complications
(both hepatic-specific and pulmonary) and shorter hospital stay, LH has become the preferred approach
[2-7]
for treating benign hepatic tumors . Even though LH has been shown to be both safe and effective; the
restricted indications for resection in the case of benign liver lesions have resulted in poorly reported long-
term outcomes. In addition, there is a need to know whether LH might improve the overall postoperative
quality of life (QoL) of patients with benign lesions [8-15] .

The aim of the present study was to evaluate the short and long-term outcomes of LH for benign liver
tumors, with special emphasis on postoperative QoL results.

METHODS
Between June 2007 and March 2018, 81 LHs were performed by a single surgical team in two hospitals
(Hospital Santa Lucia between 2007 and 2014 followed by Hospital Brasilia between 2014 and 2018). Of
these, 31 (38%) LHs performed in 30 patients bearing benign hepatic lesions formed the study population.

The indications for resection of benign liver lesions were as follows: symptomatic patients, presence of
cystadenoma, presence of hepatolithiasis and uncertain diagnosis based either on imaging or on biopsy
findings (when it was not possible to rule out malignant hepatic neoplasm). Hepatic adenoma (HA) was
also resected in the following circumstances: larger than 4-5 cm, female gender with intention to conceive,
presence of beta-catenin mutation or male gender. Resection of pyogenic liver abscess (PLA) was indicated
after failure of percutaneous drainage. All patients were studied with serum tumor markers (CEA, AFP
and Ca 19.9), abdominal ultrasonography, computed tomography and magnetic resonance imaging (MRI).
For the last seven cases, MRI with hepatobiliary contrast (Primovist; Bayer-Schering, Berlin, Germany)
was also carried out. Since 2007, our team has considered the laparoscopic approach as the first choice for
all hepatectomies except in the following situations: very large lesions (> 10 cm) in the right lobe, tumors
close to major vascular structures, or central locations. All liver resections were defined in accordance
with the International Hepato-Pancreato-Biliary Association terminology through the Brisbane
Nomenclature, 2000. Major hepatectomy was defined as resection of three or more hepatic segments. The
surgical techniques used for LH were either the intra-hepatic Glissonian approach [Figures 1 and 2] or the
extra-hepatic Glissonian approach [Figures 3 and 4], in accordance with previous standardization [7,11-13] .
Intraoperative ultrasonography was performed whenever available. Surgical specimens were preferentially
removed in an Endobag [Figure 5], by means of a Pfannenstiel incision [Figure 6] or a small right subcostal
incision. On the liver bed, a hemostatic Surgicel was used, along with fibrin glue (Eviscel) when available,
to finish the hemostasis. Finally, drains were placed only for major hepatectomies. Postoperative morbidity