A laparoscopic liver resection is a minimally invasive surgical procedure to remove a portion of the liver, avoiding the large abdominal incisions of traditional surgery. Instead, surgeons create several small entry points, typically 5 to 12 millimeters in size, to perform the operation.
Through one of these openings, a surgeon inserts a laparoscope, a thin tube with a high-definition camera and light source. This instrument transmits detailed images from inside the abdomen onto a monitor, providing a clear, magnified view of the liver. Specialized, long-handled surgical instruments are then inserted through the other incisions to dissect and remove the diseased section of the liver. The goal is to safely remove a liver mass while minimizing trauma to the body.
Conditions Treated by Laparoscopic Liver Resection
This procedure treats a variety of cancerous and non-cancerous liver conditions. The surgery is used for the removal of malignant tumors, including hepatocellular carcinoma (HCC), the most common type of primary liver cancer. Another frequent indication is the removal of colorectal liver metastases, which are tumors that have spread to the liver from the colon or rectum.
Benign, non-cancerous, tumors are also treated with this method. These include hepatic adenomas, which carry a risk of bleeding or transforming into cancer, and focal nodular hyperplasia (FNH) when it causes symptoms. Surgeons also use this technique to manage large, symptomatic liver cysts.
Beyond tumor and cyst removal, this procedure is used in living donor liver transplantation. A healthy portion of a donor’s liver is surgically removed for transplantation into a recipient, and the minimally invasive approach can benefit the donor’s recovery. The decision to use this surgical method depends on the specific condition and the patient’s overall health.
The Surgical Procedure Explained
A laparoscopic liver resection begins with the patient under general anesthesia. The surgical team makes several small incisions, or ports, in the abdomen, which serve as entry points for all the surgical tools.
Next, the surgeon inflates the abdominal cavity with carbon dioxide gas. This lifts the abdominal wall away from the internal organs, creating a safe and visible working space. With the abdomen expanded, the laparoscope is inserted through one of the ports. The camera provides a magnified, high-resolution view of the liver on a video monitor, guiding the surgeon’s movements.
Using the monitor as a guide, the surgeon manipulates specialized instruments through the other ports to perform the resection. Tools such as ultrasonic dissectors cut through liver tissue while minimizing bleeding, and vascular staplers seal blood vessels and bile ducts.
Once the diseased liver segment is detached, it is placed into a sterile surgical bag. This specimen is then removed through one of the incisions, which may be slightly enlarged. After ensuring there is no bleeding, the instruments are withdrawn, the gas is released, and the incisions are closed with sutures. The entire procedure can take between one and seven hours, depending on the extent of the liver removal.
Comparison to Traditional Open Surgery
The primary distinction between laparoscopic and traditional open surgery is the incision. Open surgery requires a single, long incision across the abdomen, while the laparoscopic approach uses several small “keyhole” incisions. This results in significantly less muscle and tissue disruption and leads to several patient advantages.
Because the incisions are smaller, patients experience less postoperative discomfort and require less pain medication. Reduced trauma to the abdominal wall also means less visible scarring.
Laparoscopic resections are also associated with less blood loss during the operation and a lower overall rate of postoperative complications. Patients undergoing the minimally invasive procedure generally have a shorter hospital stay, often two to four days compared to five to seven for open surgery.
The recovery period at home is also shorter, and patients can return to normal activities sooner. Although the time for the liver to regenerate is the same, the overall recovery from the operation itself is faster with the laparoscopic technique.
Recovery and Postoperative Care
Following a laparoscopic liver resection, recovery begins in the hospital for close monitoring. The hospital stay ranges from one to six nights, depending on the surgery’s extent. During this time, staff manage postoperative pain with medication like ibuprofen and sometimes low-dose narcotics, monitor liver function with blood tests, and check for complications like bleeding or bile leakage.
A patient’s diet is gradually reintroduced, starting with clear liquids and progressing to solid foods. Early mobilization, such as walking, is encouraged to speed up recovery and prevent blood clots.
Once discharged, the at-home recovery phase lasts from two to four weeks for many patients. Fatigue is common as the body heals and the liver regenerates. Patients should avoid strenuous activities and heavy lifting for at least six weeks and abstain from alcohol to protect the recovering liver. Most people can return to work and normal routines within six to eight weeks.
Patient Candidacy for the Procedure
Determining who is a suitable candidate for a laparoscopic liver resection requires a careful medical evaluation. Several factors related to the tumor are considered, including its size, location, and number. Patients with solitary tumors that are relatively small, often less than 5 centimeters, are good candidates.
The tumor’s location is also a factor; those in the more accessible anterolateral segments of the liver (segments II, III, IVb, V, and VI) are more amenable to a laparoscopic approach. Conversely, tumors that are very large or situated in difficult-to-reach posterior or superior segments (such as VII, VIII, and IVa) may require a traditional open surgery. While single tumors are ideal, the procedure can sometimes be performed for multiple tumors if they are favorably located.
The patient’s overall health and liver condition are also assessed. A candidate must have sufficient remaining liver function to support the body after the resection. In cases of hepatocellular carcinoma, the presence and severity of underlying cirrhosis can influence the decision. The selection process balances the benefits of a minimally invasive approach with the goal of safely removing all diseased tissue.