Reduced Opioid-Demand and Fewer Pulmonary Complications after Laparoscopic Liver Resection in the Posterior Segments

Abstract

This single-centre study aims to evaluate the advantages and limitations of laparoscopic liver resection (LLR) of lesions in the posterior segments (segments 6 and 7) in comparison to the open procedure. Institutional database between June 2014 and October 2017 was retrieved. The perioperative data and the surgical outcomes were analysed retrospectively. Out of 366 consecutive liver resections, 35 patients who met the inclusion criteria were identified. Twenty patients underwent open liver resection, while 15 patients underwent pure LLR. The technical challenge of laparoscopic access for lesions in the posterior segments could be avoided by positioning the patient in a left lateral decubitus position. The median operative time was 316 vs. 242 min (p < 0.05) in the laparoscopic and the open group respectively. Despite a comparable rate of postoperative complications, according to the Dindo-Clavien classification, less pulmonary complications and a lower opioid-demand were found in the LLR group (p < 0.05). No 90-day mortality was observed in both groups. The LLR of posterior lesions is found to be a safe and feasible approach in selected cases with significantly less postoperative pulmonary complications and lower opioid-demand, even during the learning phase.