MIS approach for liver surgery favorable to open operations: 10 thoughts

A minimally invasive approach to abdominal procedures to treat cancer may be a viable alternative to open procedures, a new study presented at the 2016 Clinical Congress of the American College of Surgeons claims.

Here's what you need to know.

1. A research team led by Lucas W. Thornblade, MD, evaluated 1,015 hepatectomies performed at 65 hospitals in 2014.

2. The researchers found that 13 percent, or 132 surgeries, were performed using MIS techniques while the rest were open operations.

3. The results showed "the odds of serious morbidity, including major bleeding, serious infections, organ failure and death were significantly lower after major liver resection performed by MIS," Dr. Thornblade said. Bile leak, liver failure, revision operation and readmission rates were similar.

4. When using MIS techniques, the surgeon inserts instruments through an incision aided by cameras, and controls the instruments inside the abdominal cavity.

5. Although the study is favorable, the procedure is not without its challenges. The surgeon is limited in his ability to control the flow of blood vessels, and that presents a major bleeding risk. The surgeon also doesn't have the same ability to expose the "targeted part of the organ during MIS."

6. Dr. Thornblade stressed the location of the tumor in relation to major blood vessels is a key consideration. "MIS may only be an option when the tumor is accessible with surgical instruments."

7. Access to trained physicians is a potential drawback to the widespread adaptation of MIS techniques. "There is a significant learning curve to mastering MIS approaches to liver resection,
and in order to see enough cases to become skillful in MIS resection, liver surgeons need to practice in a high-volume setting.

8. More research is needed on long-term disease recurrence and survival.

9. A team of experts at the International Consensus Conference on Laparoscopic Liver Resection said the procedure is innovative.

10. Dr. Thornblade's study is the largest multicenter study evaluating outcomes.

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