Adoption of pure laparoscopic liver resections: a single-institution experience with the first 1000 consecutive...

This study presents a single institution's experience with 1000 consecutive pure LLR, analyzing trends, outcomes, and predictors of open conversion over a 17-year period.

A retrospective review was conducted on 1000 consecutive LLR cases performed at Singapore General Hospital between 2006 and 2023. Patients were stratified into five groups of 200 cases to evaluate temporal trends. Clinical, operative, and pathological data were analyzed, with outcomes assessed based on morbidity, mortality, and open conversion rates.

Among the 1000 cases, 57.7% were classified as low difficulty (IMM I), with 75.2% performed for malignant indications. The overall open conversion rate was 5.2%, with a median operative time of 230 min and a median post-operative hospital stay of 4 days. Over time, LLR was increasingly performed in older patients with higher surgical risk, more complex resections, and difficult tumor locations. While intraoperative blood transfusions and conversion rates declined, post-operative morbidity increased due to the rising complexity of cases. Institutional experience and the presence of liver cirrhosis were identified as significant predictors of open conversion.

This study demonstrates the feasibility and safety of adopting LLR in a high-volume center. Despite increasing patient complexity, advances in surgical expertise and technology have contributed to improved outcomes, lower conversion rates, and expanding indications for LLR. These findings support the broader integration of pure LLR into specialized liver centers worldwide.