Starting a new laparoscopic liver surgery program: initial experience and improved efficiency.

Background: Owing to the anatomic complexity of the liver and the risk of hemorrhage, most liver resections are still performed using an open procedure. We evaluated the outcomes of introducing a laparoscopic liver program to a community teaching hospital.

Methods: We retrospectively reviewed laparoscopic liver resections performed between August 2010 and July 2013 at St. Joseph's Health Centre in Toronto. The primary outcomes were mortality, major morbidity and negative margins. Secondary outcomes included other perioperative outcomes. We used nonparametric tests to compare the outcomes during the first (group A) and second (group B) halves of the study period.

Results: Group A included 19 patients and group B had 25 patients; 9 and 4 patients, respectively, had major resections. Group A had the only death due to liver failure. There was no difference in major complications (10.6% v. 16%) or length of stay (4.5 v. 4.6 d) between the groups. One patient in group B had a positive margin. There was a significant decrease in duration of surgery (from 237 to 170 min, p = 0.007), with a trend toward shorter duration for major resections (from 318 to 238 min, p = 0.07). Furthermore, more procedures were performed for malignancy in group B than group A (36.8% v. 84.0%, p = 0.001).

Conclusion: Laparoscopic liver resection can be safely introduced into a Canadian community teaching hospital. Average duration of surgery decreased by 67 minutes despite a 2-fold increase in the number of cases performed for malignancy.