Position on laparoscopic liver surgery

Joseph F. Buell, Daniel Cherqui, David A. Geller, Nicholas O'Rourke, David Iannitti, Ibrahim Dagher, Alan J. Koffron, Mark Thomas, Brice Gayet, Ho Seong Han, Go Wakabayashi, Giulio Belli, Hironori Kaneko, Chen Guo Ker, Olivier Scatton, Alexis Laurent, Eddie K. Abdalla, Prosanto Chaudhury, Erik Dutson, Clark GamblinMichael D'Angelica, David Nagorney, Giuliano Testa, Daniel Labow, Derrik Manas, Ronnie T. Poon, Heidi Nelson, Robert Martin, Bryan Clary, Wright C. Pinson, John Martinie, Jean Nicolas Vauthey, Robert Goldstein, Sasan Roayaie, David Barlet, Joseph Espat, Michael Abecassis, Myrddin Rees, Yuman Fong, Kelly M. McMasters, Christoph Broelsch, Ron Busuttil, Jacques Belghiti, Steven Strasberg, Ravi S. Chari

Research output: Contribution to journalArticle

804 Citations (Scopus)

Abstract

Objective: To summarize the current world position on laparoscopic liver surgery. Summary Background Data: Multiple series have reported on the safety and efficacy of laparoscopic liver surgery. Small and medium sized procedures have become commonplace in many centers, while major laparoscopic liver resections have been performed with efficacy and safety equaling open surgery in highly specialized centers. Although the field has begun to expand rapidly, no consensus meeting has been convened to discuss the evolving field of laparoscopic liver surgery. Methods: On November 7 to 8, 2008, 45 experts in hepatobiliary surgery were invited to participate in a consensus conference convened in Louisville, KY, US. In addition, over 300 attendees were present from 5 continents. The conference was divided into sessions, with 2 moderators assigned to each, so as to stimulate discussion and highlight controversies. The format of the meeting varied from formal presentation of experiential data to expert opinion debates. Written and video records of the presentations were produced. Specific areas of discussion included indications for surgery, patient selection, surgical techniques, complications, patient safety, and surgeon training. Results: The consensus conference used the terms pure laparoscopy, handassisted laparoscopy, and the hybrid technique to define laparoscopic liver procedures. Currently acceptable indications for laparoscopic liver resection are patients with solitary lesions, 5 cm or less, located in liver segments 2 to 6. The laparoscopic approach to left lateral sectionectomy should be considered standard practice. Although all types of liver resection can be performed laparoscopically, major liver resections (eg, right or left hepatectomies) should be reserved for experienced surgeons facile with more advanced laparoscopic hepatic resections. Conversion should be performed for difficult resections requiring extended operating times, and for patient safety, and should be considered prudent surgical practice rather than failure. In emergent situations, efforts should be made to control bleeding before converting to a formal open approach. Utilization of a hand assist or hybrid technique may be faster, safer, and more efficacious. Indications for surgery for benign hepatic lesions should not be widened simply because the surgery can be done laparoscopically. Although data presented on colorectal metastases did not reveal an adverse effect of the laparoscopic approach on oncological outcomes in terms of margins or survival, adequacy of margins and ability to detect occult lesions are concerns. The pure laparoscopic technique of left lateral sectionectomy was used for adult to child donation while the hybrid approach has been the only one reported to date in the case of adult to adult right lobe donation. Laparoscopic liver surgery has not been tested by controlled trials for efficacy or safety. A prospective randomized trial appears to be logistically prohibitive; however, an international registry should be initiated to document the role and safety of laparoscopic liver resection. Conclusions: Laparoscopic liver surgery is a safe and effective approach to the management of surgical liver disease in the hands of trained surgeons with experience in hepatobiliary and laparoscopic surgery. National and international societies, as well as governing boards, should become involved in the goal of establishing training standards and credentialing, to ensure consistent standards and clinical outcomes.

Original languageEnglish (US)
Pages (from-to)825-830
Number of pages6
JournalAnnals of Surgery
Volume250
Issue number5
DOIs
StatePublished - Nov 2009
Externally publishedYes

Fingerprint

Laparoscopy
Liver
Safety
Patient Safety
Governing Board
Credentialing
Expert Testimony
Hepatectomy
Patient Selection
Registries
Liver Diseases
Hand
Hemorrhage
Neoplasm Metastasis

ASJC Scopus subject areas

  • Surgery

Cite this

Buell, J. F., Cherqui, D., Geller, D. A., O'Rourke, N., Iannitti, D., Dagher, I., ... Chari, R. S. (2009). Position on laparoscopic liver surgery. Annals of Surgery, 250(5), 825-830. https://doi.org/10.1097/SLA.0b013e3181b3b2d8

Position on laparoscopic liver surgery. / Buell, Joseph F.; Cherqui, Daniel; Geller, David A.; O'Rourke, Nicholas; Iannitti, David; Dagher, Ibrahim; Koffron, Alan J.; Thomas, Mark; Gayet, Brice; Han, Ho Seong; Wakabayashi, Go; Belli, Giulio; Kaneko, Hironori; Ker, Chen Guo; Scatton, Olivier; Laurent, Alexis; Abdalla, Eddie K.; Chaudhury, Prosanto; Dutson, Erik; Gamblin, Clark; D'Angelica, Michael; Nagorney, David; Testa, Giuliano; Labow, Daniel; Manas, Derrik; Poon, Ronnie T.; Nelson, Heidi; Martin, Robert; Clary, Bryan; Pinson, Wright C.; Martinie, John; Vauthey, Jean Nicolas; Goldstein, Robert; Roayaie, Sasan; Barlet, David; Espat, Joseph; Abecassis, Michael; Rees, Myrddin; Fong, Yuman; McMasters, Kelly M.; Broelsch, Christoph; Busuttil, Ron; Belghiti, Jacques; Strasberg, Steven; Chari, Ravi S.

In: Annals of Surgery, Vol. 250, No. 5, 11.2009, p. 825-830.

Research output: Contribution to journalArticle

Buell, JF, Cherqui, D, Geller, DA, O'Rourke, N, Iannitti, D, Dagher, I, Koffron, AJ, Thomas, M, Gayet, B, Han, HS, Wakabayashi, G, Belli, G, Kaneko, H, Ker, CG, Scatton, O, Laurent, A, Abdalla, EK, Chaudhury, P, Dutson, E, Gamblin, C, D'Angelica, M, Nagorney, D, Testa, G, Labow, D, Manas, D, Poon, RT, Nelson, H, Martin, R, Clary, B, Pinson, WC, Martinie, J, Vauthey, JN, Goldstein, R, Roayaie, S, Barlet, D, Espat, J, Abecassis, M, Rees, M, Fong, Y, McMasters, KM, Broelsch, C, Busuttil, R, Belghiti, J, Strasberg, S & Chari, RS 2009, 'Position on laparoscopic liver surgery', Annals of Surgery, vol. 250, no. 5, pp. 825-830. https://doi.org/10.1097/SLA.0b013e3181b3b2d8
Buell JF, Cherqui D, Geller DA, O'Rourke N, Iannitti D, Dagher I et al. Position on laparoscopic liver surgery. Annals of Surgery. 2009 Nov;250(5):825-830. https://doi.org/10.1097/SLA.0b013e3181b3b2d8
Buell, Joseph F. ; Cherqui, Daniel ; Geller, David A. ; O'Rourke, Nicholas ; Iannitti, David ; Dagher, Ibrahim ; Koffron, Alan J. ; Thomas, Mark ; Gayet, Brice ; Han, Ho Seong ; Wakabayashi, Go ; Belli, Giulio ; Kaneko, Hironori ; Ker, Chen Guo ; Scatton, Olivier ; Laurent, Alexis ; Abdalla, Eddie K. ; Chaudhury, Prosanto ; Dutson, Erik ; Gamblin, Clark ; D'Angelica, Michael ; Nagorney, David ; Testa, Giuliano ; Labow, Daniel ; Manas, Derrik ; Poon, Ronnie T. ; Nelson, Heidi ; Martin, Robert ; Clary, Bryan ; Pinson, Wright C. ; Martinie, John ; Vauthey, Jean Nicolas ; Goldstein, Robert ; Roayaie, Sasan ; Barlet, David ; Espat, Joseph ; Abecassis, Michael ; Rees, Myrddin ; Fong, Yuman ; McMasters, Kelly M. ; Broelsch, Christoph ; Busuttil, Ron ; Belghiti, Jacques ; Strasberg, Steven ; Chari, Ravi S. / Position on laparoscopic liver surgery. In: Annals of Surgery. 2009 ; Vol. 250, No. 5. pp. 825-830.
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abstract = "Objective: To summarize the current world position on laparoscopic liver surgery. Summary Background Data: Multiple series have reported on the safety and efficacy of laparoscopic liver surgery. Small and medium sized procedures have become commonplace in many centers, while major laparoscopic liver resections have been performed with efficacy and safety equaling open surgery in highly specialized centers. Although the field has begun to expand rapidly, no consensus meeting has been convened to discuss the evolving field of laparoscopic liver surgery. Methods: On November 7 to 8, 2008, 45 experts in hepatobiliary surgery were invited to participate in a consensus conference convened in Louisville, KY, US. In addition, over 300 attendees were present from 5 continents. The conference was divided into sessions, with 2 moderators assigned to each, so as to stimulate discussion and highlight controversies. The format of the meeting varied from formal presentation of experiential data to expert opinion debates. Written and video records of the presentations were produced. Specific areas of discussion included indications for surgery, patient selection, surgical techniques, complications, patient safety, and surgeon training. Results: The consensus conference used the terms pure laparoscopy, handassisted laparoscopy, and the hybrid technique to define laparoscopic liver procedures. Currently acceptable indications for laparoscopic liver resection are patients with solitary lesions, 5 cm or less, located in liver segments 2 to 6. The laparoscopic approach to left lateral sectionectomy should be considered standard practice. Although all types of liver resection can be performed laparoscopically, major liver resections (eg, right or left hepatectomies) should be reserved for experienced surgeons facile with more advanced laparoscopic hepatic resections. Conversion should be performed for difficult resections requiring extended operating times, and for patient safety, and should be considered prudent surgical practice rather than failure. In emergent situations, efforts should be made to control bleeding before converting to a formal open approach. Utilization of a hand assist or hybrid technique may be faster, safer, and more efficacious. Indications for surgery for benign hepatic lesions should not be widened simply because the surgery can be done laparoscopically. Although data presented on colorectal metastases did not reveal an adverse effect of the laparoscopic approach on oncological outcomes in terms of margins or survival, adequacy of margins and ability to detect occult lesions are concerns. The pure laparoscopic technique of left lateral sectionectomy was used for adult to child donation while the hybrid approach has been the only one reported to date in the case of adult to adult right lobe donation. Laparoscopic liver surgery has not been tested by controlled trials for efficacy or safety. A prospective randomized trial appears to be logistically prohibitive; however, an international registry should be initiated to document the role and safety of laparoscopic liver resection. Conclusions: Laparoscopic liver surgery is a safe and effective approach to the management of surgical liver disease in the hands of trained surgeons with experience in hepatobiliary and laparoscopic surgery. National and international societies, as well as governing boards, should become involved in the goal of establishing training standards and credentialing, to ensure consistent standards and clinical outcomes.",
author = "Buell, {Joseph F.} and Daniel Cherqui and Geller, {David A.} and Nicholas O'Rourke and David Iannitti and Ibrahim Dagher and Koffron, {Alan J.} and Mark Thomas and Brice Gayet and Han, {Ho Seong} and Go Wakabayashi and Giulio Belli and Hironori Kaneko and Ker, {Chen Guo} and Olivier Scatton and Alexis Laurent and Abdalla, {Eddie K.} and Prosanto Chaudhury and Erik Dutson and Clark Gamblin and Michael D'Angelica and David Nagorney and Giuliano Testa and Daniel Labow and Derrik Manas and Poon, {Ronnie T.} and Heidi Nelson and Robert Martin and Bryan Clary and Pinson, {Wright C.} and John Martinie and Vauthey, {Jean Nicolas} and Robert Goldstein and Sasan Roayaie and David Barlet and Joseph Espat and Michael Abecassis and Myrddin Rees and Yuman Fong and McMasters, {Kelly M.} and Christoph Broelsch and Ron Busuttil and Jacques Belghiti and Steven Strasberg and Chari, {Ravi S.}",
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TY - JOUR

T1 - Position on laparoscopic liver surgery

AU - Buell, Joseph F.

AU - Cherqui, Daniel

AU - Geller, David A.

AU - O'Rourke, Nicholas

AU - Iannitti, David

AU - Dagher, Ibrahim

AU - Koffron, Alan J.

AU - Thomas, Mark

AU - Gayet, Brice

AU - Han, Ho Seong

AU - Wakabayashi, Go

AU - Belli, Giulio

AU - Kaneko, Hironori

AU - Ker, Chen Guo

AU - Scatton, Olivier

AU - Laurent, Alexis

AU - Abdalla, Eddie K.

AU - Chaudhury, Prosanto

AU - Dutson, Erik

AU - Gamblin, Clark

AU - D'Angelica, Michael

AU - Nagorney, David

AU - Testa, Giuliano

AU - Labow, Daniel

AU - Manas, Derrik

AU - Poon, Ronnie T.

AU - Nelson, Heidi

AU - Martin, Robert

AU - Clary, Bryan

AU - Pinson, Wright C.

AU - Martinie, John

AU - Vauthey, Jean Nicolas

AU - Goldstein, Robert

AU - Roayaie, Sasan

AU - Barlet, David

AU - Espat, Joseph

AU - Abecassis, Michael

AU - Rees, Myrddin

AU - Fong, Yuman

AU - McMasters, Kelly M.

AU - Broelsch, Christoph

AU - Busuttil, Ron

AU - Belghiti, Jacques

AU - Strasberg, Steven

AU - Chari, Ravi S.

PY - 2009/11

Y1 - 2009/11

N2 - Objective: To summarize the current world position on laparoscopic liver surgery. Summary Background Data: Multiple series have reported on the safety and efficacy of laparoscopic liver surgery. Small and medium sized procedures have become commonplace in many centers, while major laparoscopic liver resections have been performed with efficacy and safety equaling open surgery in highly specialized centers. Although the field has begun to expand rapidly, no consensus meeting has been convened to discuss the evolving field of laparoscopic liver surgery. Methods: On November 7 to 8, 2008, 45 experts in hepatobiliary surgery were invited to participate in a consensus conference convened in Louisville, KY, US. In addition, over 300 attendees were present from 5 continents. The conference was divided into sessions, with 2 moderators assigned to each, so as to stimulate discussion and highlight controversies. The format of the meeting varied from formal presentation of experiential data to expert opinion debates. Written and video records of the presentations were produced. Specific areas of discussion included indications for surgery, patient selection, surgical techniques, complications, patient safety, and surgeon training. Results: The consensus conference used the terms pure laparoscopy, handassisted laparoscopy, and the hybrid technique to define laparoscopic liver procedures. Currently acceptable indications for laparoscopic liver resection are patients with solitary lesions, 5 cm or less, located in liver segments 2 to 6. The laparoscopic approach to left lateral sectionectomy should be considered standard practice. Although all types of liver resection can be performed laparoscopically, major liver resections (eg, right or left hepatectomies) should be reserved for experienced surgeons facile with more advanced laparoscopic hepatic resections. Conversion should be performed for difficult resections requiring extended operating times, and for patient safety, and should be considered prudent surgical practice rather than failure. In emergent situations, efforts should be made to control bleeding before converting to a formal open approach. Utilization of a hand assist or hybrid technique may be faster, safer, and more efficacious. Indications for surgery for benign hepatic lesions should not be widened simply because the surgery can be done laparoscopically. Although data presented on colorectal metastases did not reveal an adverse effect of the laparoscopic approach on oncological outcomes in terms of margins or survival, adequacy of margins and ability to detect occult lesions are concerns. The pure laparoscopic technique of left lateral sectionectomy was used for adult to child donation while the hybrid approach has been the only one reported to date in the case of adult to adult right lobe donation. Laparoscopic liver surgery has not been tested by controlled trials for efficacy or safety. A prospective randomized trial appears to be logistically prohibitive; however, an international registry should be initiated to document the role and safety of laparoscopic liver resection. Conclusions: Laparoscopic liver surgery is a safe and effective approach to the management of surgical liver disease in the hands of trained surgeons with experience in hepatobiliary and laparoscopic surgery. National and international societies, as well as governing boards, should become involved in the goal of establishing training standards and credentialing, to ensure consistent standards and clinical outcomes.

AB - Objective: To summarize the current world position on laparoscopic liver surgery. Summary Background Data: Multiple series have reported on the safety and efficacy of laparoscopic liver surgery. Small and medium sized procedures have become commonplace in many centers, while major laparoscopic liver resections have been performed with efficacy and safety equaling open surgery in highly specialized centers. Although the field has begun to expand rapidly, no consensus meeting has been convened to discuss the evolving field of laparoscopic liver surgery. Methods: On November 7 to 8, 2008, 45 experts in hepatobiliary surgery were invited to participate in a consensus conference convened in Louisville, KY, US. In addition, over 300 attendees were present from 5 continents. The conference was divided into sessions, with 2 moderators assigned to each, so as to stimulate discussion and highlight controversies. The format of the meeting varied from formal presentation of experiential data to expert opinion debates. Written and video records of the presentations were produced. Specific areas of discussion included indications for surgery, patient selection, surgical techniques, complications, patient safety, and surgeon training. Results: The consensus conference used the terms pure laparoscopy, handassisted laparoscopy, and the hybrid technique to define laparoscopic liver procedures. Currently acceptable indications for laparoscopic liver resection are patients with solitary lesions, 5 cm or less, located in liver segments 2 to 6. The laparoscopic approach to left lateral sectionectomy should be considered standard practice. Although all types of liver resection can be performed laparoscopically, major liver resections (eg, right or left hepatectomies) should be reserved for experienced surgeons facile with more advanced laparoscopic hepatic resections. Conversion should be performed for difficult resections requiring extended operating times, and for patient safety, and should be considered prudent surgical practice rather than failure. In emergent situations, efforts should be made to control bleeding before converting to a formal open approach. Utilization of a hand assist or hybrid technique may be faster, safer, and more efficacious. Indications for surgery for benign hepatic lesions should not be widened simply because the surgery can be done laparoscopically. Although data presented on colorectal metastases did not reveal an adverse effect of the laparoscopic approach on oncological outcomes in terms of margins or survival, adequacy of margins and ability to detect occult lesions are concerns. The pure laparoscopic technique of left lateral sectionectomy was used for adult to child donation while the hybrid approach has been the only one reported to date in the case of adult to adult right lobe donation. Laparoscopic liver surgery has not been tested by controlled trials for efficacy or safety. A prospective randomized trial appears to be logistically prohibitive; however, an international registry should be initiated to document the role and safety of laparoscopic liver resection. Conclusions: Laparoscopic liver surgery is a safe and effective approach to the management of surgical liver disease in the hands of trained surgeons with experience in hepatobiliary and laparoscopic surgery. National and international societies, as well as governing boards, should become involved in the goal of establishing training standards and credentialing, to ensure consistent standards and clinical outcomes.

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