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Page 6 of 11 Pais-Costa et al. Mini-invasive Surg 2018;2:33 I http://dx.doi.org/10.20517/2574-1225.2018.33

Table 2. Operative characteristics and postoperative outcomes
Variable Value
Type of hepatectomy, n (%)
Right hepatectomy 4 (12.9)
Left hepatectomy 6 (19.3)
RPS 8 (25.8)
LLS 8 (25.8)
Segmentectomy 5 2 (6.4)
Segmentectomy 6 1 (3.2)
Segmentectomy 3 1 (3.2)
Segmentectomy 2 1 (3.2)
Operative time, min, median (range) 135 (60-265)
Blood loss, mL, median (range) 125 (0-1000)
Major morbidity, n (%) 2 (6.2)
Mortality, n (%) 0 (0)
Hospital stay, days, median (range) 4 (1-32)
Time to normal activities, days, median (range) 14 (7-32)
RPS: right posterior sectionectomy; LLS: left lateral sectionectomy

abdominal pain and sensation of epigastric fullness (n = 2) and visceral compression (n = 1). For most
patients, preoperative diagnosis was made from typical findings seen on either CT or MRI. Three patients
with HA underwent a percutaneous biopsy that confirmed the presence of beta-catenin mutation. One
patient underwent intraoperative frozen-section biopsy because preoperative examinations presented a
differential diagnosis with hepatocellular carcinoma, and FNH was then confirmed in this case. There were
3 patients who presented multiple lesions, 1 patient had 6 lesions (FNH) and 2 patients had 3 lesions each
(HA).

Thirty-one liver resections were performed in 30 patients (1 patient underwent 2 independent resections,
both of them by means of a laparoscopic approach). The majority of liver resections were minor (64.5%)
and there were two open conversions in this series (6.4%). One patient underwent conversion due to severe
intraoperative bleeding (> 750 mL) and the other due to technical difficulties. The first was an obese male
operated on for a 10 cm symptomatic giant hemangioma in the dome of the left liver, very close to the left
hepatic vein, which was injured due to a stapler failure. The stapler was fired but it was not possible to open
it and, thus, an open repair became necessary. This patient was the only one in this series who required
postoperative blood transfusions (3.3%). The second case was a female with a cystadenoma in the left lobe
who presented multiple adhesions between the small intestine and the liver due to a previous surgery.
Pringle maneuver was performed in a single case who underwent open conversion due to intraoperative
bleeding. Eight patients underwent surgical drainage of the liver bed by means of a tubular drain. Details
of the surgical procedures are shown in Table 2.

Two patients (6.4 %) presented postoperative complications (grade 3), and these were the same 2 patients
who underwent open conversion [Table 2]. One patient presented a biliary fistula that required endoscopic
retrograde cholangiopancreatography with stent placement, and the other developed an incisional hernia
that required a laparoscopic repair six months after surgery. There was no gas embolism in this series.
Mortality was nil. The median hospital stay was 4 days (range 1-32 days) for the overall series, and 2 days
(range 1-3 days) considering only the minor resections. Eighteen patients required low doses of common
analgesics for 2 or 3 days during their postoperative course, while 10 patients required them for 4 days
and 2 patients for 6 days. Both patients who underwent open conversion required narcotic analgesia.
The median length of time taken to return to normal daily activities was 14 days (range 7-32 days) for
the overall series, and 9 days (range 7-12 days) considering only the cases of monosegmentectomy. These
findings are shown in Table 2. Among the symptomatic patients, all of them achieved complete symptom