Related Experiment Video
Updated: Apr 19, 2026
Laparoscopic Anterior Right Hepatectomy: A Single-Center Experience
Published on: December 4, 2023
Risk factors for complications after laparoscopic major hepatectomy
T Nomi1, D Fuks, M Govindasamy
1Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France; Department of Surgery, Nara Medical University, Nara, Japan.
Background:
Although laparoscopic major hepatectomy (MH) is becoming increasingly common in several specialized centres, data regarding outcomes are limited. The aim of this study was to identify the risk factors for postoperative complications of purely laparoscopic MH at a single centre.
Methods:
All patients who underwent purely laparoscopic MH between January 1998 and March 2014 at the authors' institution were enrolled. Demographic, clinicopathological and perioperative factors were collected prospectively, and data were analysed retrospectively. The dependent variables studied were the occurrence of overall and major complications (Dindo-Clavien grade III or above).
Results:
A total of 183 patients were enrolled. The types of MH included left-sided hepatectomy in 40 patients (21·9 per cent), right-sided hepatectomy in 135 (73·8 per cent) and central hepatectomy in eight (4·4 per cent). Median duration of surgery was 255 (range 100-540) min, and median blood loss was 280 (10-4500) ml. Complications occurred in 100 patients (54·6 per cent), and the 90-day all-cause mortality rate was 2·7 per cent. Liver-specific and general complications occurred in 62 (33·9 per cent) and 38 (20·8 per cent) patients respectively. Multivariable analysis identified one independent risk factor for global postoperative complications: intraoperative simultaneous radiofrequency ablation (RFA) (odds ratio (OR) 6·93, 95 per cent c.i. 1·49 to 32·14; P = 0·013). There were two independent risk factors for major complications: intraoperative blood transfusion (OR 2·50, 1·01 to 6·23; P = 0·049) and bilobar resection (OR 2·47, 1·00 to 6·06; P = 0·049).
Conclusion:
Purely laparoscopic MH is feasible and safe. Simultaneous RFA and bilobar resection should probably be avoided.
Insights
Purely laparoscopic major hepatectomy (MH) is safe, but surgeons should avoid simultaneous radiofrequency ablation (RFA) and bilobar resection to reduce complications. This study identifies key risk factors for adverse outcomes in laparoscopic MH.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Laparoscopic major hepatectomy (MH) is increasingly adopted in specialized centers.
- Limited data exists on the outcomes and risk factors associated with purely laparoscopic MH.
- This study aims to identify risk factors for postoperative complications in purely laparoscopic MH.
Purpose of the Study:
- To identify risk factors for overall and major postoperative complications after purely laparoscopic major hepatectomy.
- To evaluate the safety and feasibility of purely laparoscopic MH.
- To provide evidence-based recommendations for improving patient outcomes.
Main Methods:
- Retrospective analysis of prospectively collected data from 183 patients undergoing purely laparoscopic MH (1998-2014).
- Inclusion of demographic, clinicopathological, and perioperative factors.
- Statistical analysis to determine independent risk factors for overall and major complications (Dindo-Clavien grade III or above).
Main Results:
- Overall complications occurred in 54.6% of patients; major complications (grade III+) were also assessed.
- Intraoperative simultaneous radiofrequency ablation (RFA) was an independent risk factor for global complications (OR 6.93).
- Intraoperative blood transfusion (OR 2.50) and bilobar resection (OR 2.47) were independent risk factors for major complications.
Conclusions:
- Purely laparoscopic major hepatectomy is a feasible and safe procedure.
- Simultaneous RFA and bilobar resection are associated with increased risk and should be avoided.
- Findings guide surgical decision-making to minimize complications in laparoscopic MH.
