Systematic review of 241 laparoscopic isolated liver segment VII resections

Laparoscopic liver resections are performed with increasing frequency; however, they are less preferred for the deep parts of liver because of difficulty in reaching a posterior superior segment and working in a narrow area. The aim of this study is to analyze the outcomes of laparoscopic segment 7 resections with two new patients and previously published 239 patients. PubMed, Scopus, and Google Scholar databases were scanned for the topic with several keywords. Eligible studies were selected for the analysis and reference cross-check was added to the search. Surgical technique details (application of Pringle maneuver, using Cavitron ultrasonic surgical aspirator (CUSA), patient position, Glissonean approach, and intercostal trocar (ICT) placement) were examined for the outcomes (operating time, blood loss, conversion to open surgery, and post-operative complications). Total data of 239 cases were collected from 27 studies and we added two more cases from our clinic. Lateral decubitus patient position was with less post-operative complications when compared to the supine position (8.4% vs. 50.0%, p=0.01). ICT placement seemed to have less conversion rate (1.3% vs. 7.3%, p=0.07) and less post-operative complications (4.5% vs. 19.1%, p=0.05). Glissonean approach increased the operating time but had no effect on blood loss. Using CUSA for parenchymal transection lowered the rates of post-operative complications (4.4% vs. 19.5%, p<0.05) but it was not useful for blood loss or operating time. Application of Pringle maneuver had no effect on these outcomes. Laparoscopic isolated segment 7 liver resection is a feasible surgical procedure for selected patients in centers with experienced surgeons on advanced laparoscopy. Lateral decubitus patient position, ICT placement, and using CUSA for parenchymal transection seem beneficial to decrease conversion to open surgery and complication rates. Pringle maneuver or Glissonean approach were not found as useful for the outcomes.