Between 1997 and 2007, the celioscopic approach was used for 159 (23%) of the 698 hepatic resections performed at Henri Mondor Hospital. The main selection criteria were the location and size of the lesions. Most lesions were located in anterolateral segments (segments 2 to 6) and were smaller than 50 mm. With experience, the team started to perform major
hepatectomies for more deep-seated lesions. The patients were 84 women and 75 men. The indications were benign in 65 cases (40%) and malignant in 94 cases (60%). The most frequent benign disorders were symptomatic hepatocyte
tumors and
tumors of uncertain nature (
adenomas and
focal nodular hyperplasia in 40 cases). The malignant lesions comprised 60 cases of
hepatocellular carcinoma on a cirrhotic liver and 20
metastases of
colorectal cancer. The
tumors had a diameter of 44 mm (range 4-170 mm). The technique involved 5
trocars,
pneumoperitoneum, and parenchymal section with a combination of a harmonic scalpel, an ultrasonic dissector, and automatic staplers. Intermittent pedicular clamping was used if necessary. The specimen was removed in a protective bag. Manual assistance was used in 14 cases (9%), while the other cases involved a pure coelioscopic approach. Major
hepatectomy (three or more segments) was performed in 27 cases (17%) and minor resection in 132 cases (83%). There were 17 right
hepatectomies, 11 left
hepatectomies, 52 left lobectomies, 37 mono- or bisegmentectomies and 43 atypical resections. The overall laparotomic conversion rate was 10% (16 cases). The reasons for conversion were
bleeding in 10 cases and inadequate exposure or progression in 6 cases. The mean operating time was 204 minutes. Nine patients (6%) received
blood transfusions. There were no postoperative deaths and the morbidity rate was 18%. The mean
resection margin for malignant
tumors was 14 mm and there were no relapses on the
trocar ports. This series demonstrates the feasibility of celioscopic hepatic resection in selected patients. These operations necessitate expertise in hepatic surgery and advanced coelioscopy, as well as sophisticated instrumentation. The advantages are those of
minimally invasive surgery, and simpler re-operation for further
hepatectomy or
transplantation.