Video assisted resections. Increasing access to minimally invasive liver surgery?

Objective: To evaluate perioperative outcomes, safety and feasibility of video-assisted resection for primary and secondary liver lesions. Methods : From a prospective database, we analyzed the perioperative results (up to 90 days) of 25 consecutive patients undergoing video-assisted resections in the period between June 2007 and June 2013. Results : The mean age was 53.4 years (23-73) and 16 (64%) patients were female. Of the total, 84% were suffering from malignant diseases. We performed 33 resections (1 to 4 nodules per patient). The procedures performed were non-anatomical resections (n = 26), segmentectomy (n = 1), 2/3 bisegmentectomy (n = 1), 6/7 bisegmentectomy (n = 1), left hepatectomy (n = 2) and right hepatectomy (n = 2). The procedures contemplated postero-superior segments in 66.7%, requiring multiple or larger resections. The average operating time was 226 minutes (80-420), and anesthesia time, 360 minutes (200-630). The average size of resected nodes was 3.2 cm (0.8 to 10) and the surgical margins were free in all the analyzed specimens. Eight percent of patients needed blood transfusion and no case was converted to open surgery. The length of stay was 6.5 days (3-16). Postoperative complications occurred in 20% of patients, with no perioperative mortality. Conclusion : The video-assisted liver resection is feasible and safe and should be part of the liver surgeon armamentarium for resection of primary and secondary liver lesions.

研究目的：本研究旨在评估原发性及继发性肝脏病灶电视辅助肝脏切除术（video-assisted resection）的围手术期结局、安全性与可行性。
研究方法：本研究依托一项前瞻性数据库，分析了2007年6月至2013年6月期间接受电视辅助肝脏切除术的25例连续入组患者的围手术期结局（随访至术后90天）。
研究结果：本队列患者的平均年龄为53.4岁（范围23~73岁），其中女性16例，占比64%。总计84%的患者罹患恶性疾病。本研究共实施33次肝脏切除术，每位患者切除1~4个病灶结节。本次实施的手术方式包括：非解剖性肝切除术26例次、肝段切除术1例次、2/3段双肝段切除术1例次、6/7段双肝段切除术1例次、左肝切除术2例次以及右肝切除术2例次。66.7%的手术涉及肝脏后上段病灶，因此需实施多灶或大范围切除术。手术平均时长为226分钟（范围80~420分钟），麻醉平均时长为360分钟（范围200~630分钟）。切除病灶结节的平均直径为3.2cm（范围0.8~10cm），所有送检标本的手术切缘均为阴性。8%的患者需接受输血治疗，无一例中转开腹手术。患者平均住院时长为6.5天（范围3~16天）。20%的患者出现术后并发症，无围手术期死亡病例。
研究结论：电视辅助肝脏切除术具备可行性与安全性，应作为肝脏外科医师治疗原发性及继发性肝脏病灶的可选术式之一。