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. 2022 May;36(5):2818-2826.
doi: 10.1007/s00464-021-08570-3. Epub 2021 May 25.

Evolution of laparoscopic liver surgery: 20-year experience of a Norwegian high-volume referral center

Davit L Aghayan  1   2 , Airazat M Kazaryan  3   4   5   6   7 , Åsmund Avdem Fretland  3   8 , Bård Røsok  8 , Leonid Barkhatov  3   5   9 , Kristoffer Lassen  8 , Bjørn Edwin  3   5   8
Affiliations

Evolution of laparoscopic liver surgery: 20-year experience of a Norwegian high-volume referral center

Davit L Aghayan et al. Surg Endosc. 2022 May.

Abstract

Background: Laparoscopic liver surgery has evolved to become a standard surgical approach in many specialized centers worldwide. In this study we present the evolution of laparoscopic liver surgery at a single high-volume referral center since its introduction in 1998.

Methods: Patients who underwent laparoscopic liver resection (LLR) between August 1998 and December 2018 at the Oslo University Hospital were analyzed. Perioperative outcomes were compared between three time periods: early (1998 to 2004), middle (2005 to 2012) and recent (2013-2018).

Results: Up to December 2020, 1533 LLRs have been performed. A total of 1232 procedures were examined (early period, n = 62; middle period, n = 367 and recent period, n = 803). Colorectal liver metastasis was the main indication for surgery (68%). The rates of conversion to laparotomy and hand-assisted laparoscopy were 3.2% and 1.4%. The median operative time and blood loss were 130 min [interquartile range (IQR), 85-190] and 220 ml (IQR, 50-600), respectively. The total postoperative complications rate was 20.3% and the 30-day mortality was 0.3%. The median postoperative stay was two (IQR, 2-4) days. When comparing perioperative outcomes between the three time periods, shorter operation time (median, from 182 to 120 min, p < 0.001), less blood loss (median, from 550 to 200 ml, p = 0.023), decreased rate of conversions to laparotomy (from 8 to 3%) and shorter postoperative hospital stay (median, from 3 to 2 days, p < 0.001) was observed in the later periods, while the number of more complex liver resections had increased.

Conclusion: During the last two decades, the indications, the number of patients and the complexity of laparoscopic liver procedures have expanded significantly. Initially being an experimental approach, laparoscopic liver surgery is now safely implemented across our unit and has become the method of choice for surgical treatment of most liver tumors.

Keywords: Laparoscopic liver resection; Laparoscopy; Liver resection; Liver surgery.

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Conflict of interest statement

Davit L. Aghayan, Airazat M. Kazaryan, Åsmund Avdem Fretland, Bård Røsok, Leonid Barkhatov, Kristoffer Lassen, and Bjørn Edwin have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Annual number of liver resections from January 1999 to December 2020
Fig. 2
Fig. 2
Extent of laparoscopic liver resections
Fig. 3
Fig. 3
Dispersion graph of operative time: from 1998 to 2018 (cases with concomitant ablations were excluded)
Fig. 4
Fig. 4
Kaplan–Meier survival curves for overall survival for patients with CRLM (n = 655), HCC (n = 80) and ICC (n = 34)
See this image and copyright information in PMC

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