Validation of the laparoscopically stapled approach as a standard technique for left lateral segment liver resection

Abstract

Background: Left lateral sectionectomy (LLS) is the most common type of anatomic laparoscopic liver resection performed, accounting for 20 % of all laparoscopic hepatectomies. Because there has been no standardized surgical technique for laparoscopic left lateral sectionectomy (LLLS), we offer an established operation: laparoscopically stapled left lateral sectionectomy (LSLLS). Our aim was to perform a case-controlled study of LSLLS with traditional (without vascular staplers) laparoscopic left lateral sectionectomy (TLLLS), validating the standardization and reproducibility of LSLLS.

Methods: From February 2009 to December 2011, a total of 49 LSLLSs were performed. The results were compared with 33 cohort-matched TLLLSs from an earlier time period. Ordered sample cluster analysis was used to determine the learning curve of LSLLS based on the operating time and blood loss.

Results: All LSLLS were performed successfully. There were no conversions to laparotomy or hand-assisted laparoscopic resection. Two endoscopic linear staplers were used in each case. Despite a higher hospital cost ($10,892 ± $944 vs. $8,962 ± $943, p < 0.05), LSLLS compared favorably with TLLLS regarding operating time (103 ± 21 vs. 151 ± 32 min, p < 0.05) and blood loss (70.8 ± 41.6 vs. 173.3 ± 131.1 ml, p < 0.05). No specific complications related to laparoscopy were observed. Ordered sample cluster analysis demonstrated a learning curve of 18 cases for LSLLS.

Conclusions: This study demonstrates the standardization and reproducibility of LSLLS. We therefore propose LSLLS as the standard technique for lesions located in the left lateral section of the liver.