The Clinical Application Of Minimal Invasive Liver Surgery

Objects: Investigate the feasibility, security and efficacy of malignanttumor treatment of minimally invasive surgery for liver diseases.Summarize indications and choices of surgical approaches of minimallyinvasive liver surgery. Summarize operation process and operation skillsof the various surgical approaches.Methods: A retrospective analysis of the179cases of minimally invasiveliver resection completed in our hospital from September2004to February2014, with110cases of pure laparoscopic liver resection (PLLR),47casesof hand-assisted laparoscopic liver resection (HALLR) and22cases ofrobot-assisted liver resection (RLR). Observe and compare differentindicators of patients, including operation time, intraoperative blood loss,laparotomy transit rate, tumor diameter, postoperative liver function index,postoperative complications, postoperative diet recovery time,postoperative hospitalization days, and postoperative survival situation. Doa comparative analysis on all the cases.Results: Among110cases of PLLR group,3cases transferred tolaparotomy. Median operation time was140(120~180)min, with medianintraoperative blood loss at200(100~300)ml, median postoperative hospitalization days of7(5~8) days, and7cases of postoperative bileleakage. Among47cases of HALLR group,3cases transferred tolaparotomy. Median operation time was180(160~235)min, with medianintraoperative blood loss at400(200~1000)ml, median postoperativehospitalization days of15(13~16) days, and2cases of postoperative bileleakage. Among22cases of RLR group,3cases transferred to laparotomy.Median operation time was140(90~180)min, with median intraoperativeblood loss at300(200~500)ml, median postoperative hospitalization daysof8(6~9) days, and1case of postoperative bile leakage. Of the threegroups of patients, PLLR group and RLR group have the shortest operationtime and least intraoperative blood loss. Results have statistical differences.PLLR group have the fastest postoperative diet recovery. Results havestatistical difference. In the postoperative follow-up of2years, there’s nostatistical difference between total survival curves and tumor-free survivalcurves of the three groups of patients. In postoperative follow-up of5years,there’s no statistical difference between total survival curves and tumor-free survival curves between PLLR group and HALLR group.Conclusion: Pure laparoscopic liver resection, hand-assisted laparoscopicliver resection and robot-assisted liver resection are all safe and feasible.For liver resections of II, III, and IVb, V, VI section, total laparoscopy is afeasible choice while robot-assisted operation system can improve the operation quality of these parts. For liver resections of I, IVb, VII, VIIIsection, hand-assisted laparoscopic is a more mature choice, further studiesin operations with robot-assisted system in these sections remains to bedone. As for the efficacy of malignant tumor treatment, in terms of short-term prognosis, the three operation methods have similar effects. In termsof long-term prognosis, robot-assisted system liver resection remains to beverified by further research results of larger samples of long-term follow-ups.