[Laparoscopic liver surgery]

Laparoscopic surgery has been widely used for digestive tract diseases, specially for gallbladder pathology. Laparoscopic liver surgery pretends to accomplish the same objectives of open surgery but with the advantages of minimally invasive surgery.

To evaluate the indications and recent results of laparoscopic liver surgery, as well as the technique.

A review of the world literature was performed on the roll of laparoscopic surgery for hepatic diseases. The results of the authors are also reported.

Nowadays hepatic laparoscopic surgery is reserved for anterior non-parasitic liver cysts and type I polycystic liver disease. The treatment of choice is wide deroofing. For hydatic liver disease pericystectomy or wide deroofing plus omentoplasty are also described. For benign solid liver disease, hepatic resection can be performed with the same outcome that the one observed with open surgery when the lesions are symptomatic, small, anterior or peripherally located. Laparoscopic liver surgery is recommended for the treatment of malignant hepatic lesions only in very specific cases. Nonetheless there are no prospective randomized studies that show benefits of laparoscopic over open surgery. Several local ablative therapies like radiofrequency, ethanol injection, cryotherapy or laser can be also performed through the laparoscope. The results reported so far have been encouraging. Intra-arterial chemotherapy is an option for the treatment of liver malignancies via laparoscopy, considering that the arterial catheter can be placed under this approach.

For years, the liver has been considered a challenging organ for its approach, even with open surgery. Laparoscopic liver surgery should be performed by an experienced surgeon with the adequate technology. To our knowledge there are no reported results that decisively point toward the benefits of laparoscopic surgery over open surgery for the management of liver disease. Nonetheless more experience in laparoscopic liver surgery is needed.