Laparoscopic liver surgery: towards a day-case management.

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgery
• Surgical Outcomes Research

Background:

• Ambulatory surgery (AS) for solid abdominal organs, including the liver, remains under investigation.
• Laparoscopic liver surgery (LLS) offers potential for minimally invasive approaches.
• Defining criteria for AS in LLS is crucial for patient selection and safety.

Purpose of the Study:

• To identify surgical criteria for safe and feasible ambulatory laparoscopic liver surgery.
• To analyze a large database of patients undergoing LLS to determine suitability for AS.
• To establish risk factors for postoperative complications in LLS.

Main Methods:

• Analysis of prospectively collected data from 994 patients undergoing pure LLS (1998-2015).
• Inclusion criteria for potential AS: ASA score <3, no extra-hepatic procedures, duration ≤180 min, blood loss ≤300 mL, no intraoperative complications, no postoperative drainage.
• Multivariate analysis to identify independent predictors of postoperative morbidity.

Main Results:

• 174 patients (17.5%) met criteria for potential AS, predominantly with benign lesions or liver metastases.
• Common procedures included wedge resections and liver cyst unroofing (74%).
• Major hepatectomy and central tumor location were independent predictors of postoperative morbidity (P<0.05).

Conclusions:

• Approximately 7% of highly selected patients undergoing specific LLS procedures may be candidates for ambulatory surgery.
• Experienced teams are essential for successful implementation of AS in LLS.
• Further research is needed to expand AS indications in liver surgery.