Recommendations for Laparoscopic Liver Resection
Comparator: Parenchymal sparing (MAJOR resections)
Result of Literature Studies: Insufficient evidence
Comment: The jury notes the concern that larger procedures resecting more liver parenchyma are sometimes favored if the procedure is done laparoscopically because a smaller parenchyma-sparing operation may be more complex laparoscopically. The magnitude of this issue is unknown.
Quality of Evidence: LOW (cohort studies, case series)
Recommendation Type A: none
Recommendation Type B: Continue to evaluate procedure as is ongoing trial. Extract data from higher quality studies that examine this variable, which has been poorly addressed. STRONG because the possibility of sparing parenchyma through magnified visualization is stated as a rationale for procedures to be done laparoscopically.
Comparator: Incisional hernia (MINOR and MAJOR resections)
Result of Literature Studies: Insufficient evidence
Recommendations: None
Comparator: Cosmetic result (MINOR and MAJOR Resections)
Result of Literature Studies: The level of evidence is based on cohort or case control studies evaluating single port approach. Although the available evidence is limited, cosmetic advantage in lap liver resection is apparent, as is the case with other laparoscopic operations.
Quality of Evidence: LOW (cohort studies, case series)
Recommendations: None
Addenda
Q1. Short-term Outcomes
Comparator: Parenchymal sparing (MAJOR resections)
Result of Literature Studies: Insufficient evidence
Comment: The jury notes the concern that larger procedures resecting more liver parenchyma are sometimes favored if the procedure is done laparoscopically because a smaller parenchyma-sparing operation may be more complex laparoscopically. The magnitude of this issue is unknown.
Quality of Evidence: LOW (cohort studies, case series)
Recommendation Type A: none
Recommendation Type B: Continue to evaluate procedure as is ongoing trial. Extract data from higher quality studies that examine this variable, which has been poorly addressed. STRONG because the possibility of sparing parenchyma through magnified visualization is stated as a rationale for procedures to be done laparoscopically.
Q2. Long-term Outcomes
Comparator: Incisional hernia (MINOR and MAJOR resections)
Result of Literature Studies: Insufficient evidence
Recommendations: None
Comparator: Cosmetic result (MINOR and MAJOR Resections)
Result of Literature Studies: The level of evidence is based on cohort or case control studies evaluating single port approach. Although the available evidence is limited, cosmetic advantage in lap liver resection is apparent, as is the case with other laparoscopic operations.
Quality of Evidence: LOW (cohort studies, case series)
Recommendations: None
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