الفهرس 
HISTORICAL BACKGROUNDOnly 14 pages are availabe for public view
 |  | from | 166 |  |  |
| | | from | 166 | | |
Abstract
The liver is an important organ which performs complex functions including metabolism, synthesis and detoxification. Chronic liver disease is a multi factorial process leading to instability and derangement of essential functions. If not rapidly reversed, complications will lead to hepatic coma. With additional organ failure, recovery becomes irreversible and leads to a high patient mortality (Brown et al., 2004).
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors, and hepatic resection is considered one of the most effective therapies in selected patients. The postoperative prognosis of patients with HCC is poor because of high rate of tumor recurrence after hepatic resection (Poon et al., 1999).
Even though hepatocellular carcinoma is generally a slowly growing tumor, the majority of patients present at advanced stage and most are beyond curative treatments. Because the liver is relatively hidden behind the right costal cartilages, tumors have to reach substantial size before they are palpable. Furthermore, the large functional reserve of the liver masks any small impairment produced by local parenchymal disturbances. Small tumors are therefore most often asymptomatic, and are usually discovered during screening programs or incidentally during imaging for other abdominal conditions (Descottes et al., 2000).
Laparoscopy has been in vogue in the surgical practice for nearly three decades now. As for as the liver is concerned, surgical fraternity were reluctant to apply the principles of minimal access surgery to hepatic resections for fear of hemorrhage and bile leak. Hence laparoscopy was restricted to minor procedures like liver biopsy and fenestration of liver cysts. With the advent of modern laparoscopic hemostatic instruments augmented with better understanding of liver anatomy as well as the pathophysiology of the hepatic tumors, laparoscopy has incorporated albeit slowly in the management of liver tumors (Cherqui et al., 2000).
Laparoscopic approach to the liver resection was first reported by Gagner et al in 1992. It was a non-anatomical resection for focal nodular hyperplasia. In 1995, Ferlzi et al reported a similar type of resection using laparoscopic approach. The first successful laparoscopic anatomical hepatic resection was reported in 1996 by Azagra et al, who performed a left lateral segmentectomy in a patient with benign adenoma of liver (Azagra et al., 2003).
To begin with, benign conditions like hemangioma and focal hyperplasia were successfully resected using laparoscopic approach. But of late, lot of studies has shown that laparoscopic liver resection for a malignant tumor is not only feasible but also safe (Watanabe et al., 1999).
The spectrum of resections that are being performed laparoscopically include segmentectomy, subsegmentectomy and wedge resection on one side and major hepatectomies and bisegmentectomies on the other side. Not to stop here, laparoscopic techniques are also employed in various other procedures like radiofrequency ablation of liver tumors and placement of hepatic artery infusion pump. And then applied to resection of the graft in the donor’s liver in transplantation (Soubrane et al., 2002).
Laparoscopic Liver Resection was associated with less blood loss, quicker resumption of oral diet, less pain medication requirement and shorter length of stay with no difference in complication rates .In those patients undergoing laparoscopic hepatic resection, there was no difference in 3-or 5- year overall survival when compared with well-matched open hepatic resection cases. Financially, the total hospital costs of laparoscopic liver resection were either offset or improved because of a shorter length of stay (Samama et al.,1998).