الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection.
Indications for LLR do not differ from those for open surgery. They include benign and malignant (both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers.
Resection of lesions located on posterosuperior segments (1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections.
LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers’ practice. Continuous surgical training, as well as new technologies should augment the application of laparoscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation.
Since the early 90s, when the first laparoscopic anatomical resection of the liver was reported, laparoscopic 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 for treating benign hepatic tumors.
The main objective of this study was to assess the feasibility and outcome of laparoscopic resection of hepatic lesions.
This was a prospective case series study was including 20 patients with hepatic focal lesions. The duration of study ranges from 6 – 12 months.
The main results of the study revealed that:
• Cases ranged between 15-68 with mean value ± SD (48.8±14.8). Male cases were 12(60.0%) while female cases were 8(40.0%).
• Tumor size was ranged from 5-12 cm2 with mean value 8.4±2.2cm2.
• Hb at preoperative was ranged between 9.7-15.7 with a mean value of 12.6±1.8.
• Operation time was ranged between 2.5-3 hours with a mean value of 2.6±0.6 hours while bleeding was ranged between 50-400 cc with a mean value of 167.5±97.7cc.
• 7(35%) patients presented with hepatocellular carcinoma, 2(10%) patients presented with cholangiocarcinoma,6(30%) patients presented with colorectal carcinoma, 3(15%) presented with hydatid cysts and 2(10%) patients presented with simple cysts.
• AOF was ranged between 12-72 hours with a mean value of 21.3±17.9 hours. Regarding the type and amount of the postoperative drainage, 8(40%) of the cases revealed serosanginous drainage with a mean value of 33.8±17.7 and 12(60%) of the cases revelead bloody drainage with a mean value of 141.7±167 and the time to discharge was ranged between 2–4days with a mean value of 2.4±0.7 days.
In conclusion, Laparoscopic liver resection should be considered the main therapeutic approach for treating selected patients with benign liver lesions who require surgical resection because it presented null mortality and low morbidity, along with rare recurrence, a good quality of life and high esthetic satisfaction.
Finally, we recommend for further studies on large geographical scale and on larger sample size with longer duration to emphasize our conclusion.