(Washington, D.C.) — A new study published in the Journal of the American College of Surgeons shows that less invasive laparoscopic-assisted liver surgery performed at MedStar Georgetown University Hospital is easier on the patient and is just as safe and effective as traditional liver surgery (also called open hepatic resection or OHR).
“We started doing the laparoscopic-assisted liver resection (LAHR) back in 2007 for our living liver transplant donors,” said Lynt B. Johnson, MD, chief of surgery at MedStar Georgetown University Hospital. “We wanted to make it easier on these donors and what we saw was a better cosmetic result, quicker release from the hospital and faster recovery time.”
The study, published in the April 2012 issue of JACS, compared 193 patients who either had the standard open surgical procedure or the newer LAHR between March 2004 and July 2011.
During this time 106 patients had the traditional surgery while 87 underwent LAHR. They analyzed the duration of the operations, estimated blood loss, complications and the length of stay in the hospital.
The findings showed that the operation time was about the same in both groups; blood loss was slightly less and complications were slightly fewer in the laparoscopic group.
“The most notable difference between the two groups of patients was their length of stay in the hospital,” said Dr. Johnson. “Those having the laparoscopic procedure went home about a day and a half earlier than those who had the standard surgery. We also saw that the laparoscopic group has less pain after surgery.”
To perform the laparoscopic-assisted liver surgery procedure the surgeon makes two small cuts for the laparoscopic tools used to visualize and move the liver as needed. A final incision, about the size of the wrist, is made for the surgeon’s hand. He then uses his hand and the laparoscopic tool to remove the desired portion of the liver.
“Before we started using this technique the typical incision was about 20 inches long; with the laparoscopic procedure the incision is about four inches in total length,” said Dr. Johnson. “I thought we could then apply this technique to other liver surgeries, which we did, and are seeing similar success.”
According to Dr. Johnson the most common reason for a liver resection is removing cancerous tumors that have spread from the colon to the liver. The technique can also be used for benign liver tumors. Of the 87 LAHR patients in the study, ten were living liver donors.
“Most surgeons didn’t believe that we could do this safely and effectively when at times, removing more than half of a person’s liver,” said Dr. Johnson. “But with the right training I think we’ve shown that an experienced liver surgeon can offer this less invasive technique as a safe alternative to traditional liver surgery.”
“We’ve now started using this technique for pancreas surgeries including close to 30 Whipple procedures. There is a great value benefit here to patients who are out of the hospital and back to work faster also resulting in lowered costs to the system as a whole,” Dr Johnson added.
The study concludes that these results might highlight the need to add this technique to the liver surgeon’s skill set.
Since 1999, MGUH has performed more liver transplants that any other center in Maryland, Virginia or the District of Columbia. MedStar Georgetown was the first transplant center in the mid-Atlantic region to offer the laparoscopic assisted live-donor liver resection technique.
The Journal of the American College of Surgeons (JACS) is the official publication of the American College of Surgeons.