Laparoscopic liver resection

Summary

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on laparoscopic liver resection.

Description

The most common indication for laparoscopic liver resection is a solitary liver metastasis from a colorectal cancer, but it may also be used for hepatocellular carcinoma (HCC) and for benign liver tumours or cysts.

Open surgical resection, to remove the affected part of the liver, is the standard treatment for patients with localised colorectal liver metastases and HCC. This procedure is performed through a large incision across the abdomen. A number of alternative therapies have also been developed, including hepatic artery infusion chemotherapy, percutaneous ethanol injection, cryoablation, microwave coagulation therapy, laser-induced thermotherapy, and radiofrequency ablation.

Benign liver tumours are usually treated only if they are causing symptoms. The standard treatment is open surgical resection.

Laparoscopic liver resection is performed under a general anaesthetic. The abdomen is insufflated with carbon dioxide and a number of small incisions are made to provide access for the laparoscope and surgical instruments. The resected liver is enclosed in a bag and removed,  through a small incision in the umbilical area.

Hand-assisted laparoscopic liver resection allows the surgeon to place one hand in the abdomen while maintaining the pneumoperitoneum required for laparoscopy. An additional small incision is made which is just large enough for the surgeon’s hand and an airtight ‘sleeve’ device is used to form a seal around the incision.

NICE Pathways

This guidance has been incorporated into the following NICE Pathways, along with other related guidance and products.

Visit the NICE Pathway: colorectal cancer

OPCS4.6 Code(s):

J02.3 Resection of segment of liver

Includes: Resection of segments of liver

                Resection of section of liver

Y75.2 Laparoscopic approach to abdominal cavity NEC orY75.4 Hand assisted minimal access approach to abdominal cavity

Or

J02.4 Wedge excision of liver

Y75.2 Laparoscopic approach to abdominal cavity NEC orY75.4 Hand assisted minimal access approach to abdominal cavity

_{The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.  www.connectingforhealth.co.uk/clinicalcoding}

 

Details

Contact details:

Links:

	IPG135 Laparoscopic liver resection - guidance	27 July 2005
	IPG135 Laparoscopic liver resection: guidance (web format)	10 February 2011
	IPG135 Laparoscopic liver resection - information for the public	27 July 2005
	Interventional Procedures Consultation Document - laparoscopic liver resection	29 March 2005
	Interventional procedures overview of laparoscopic liver resection	29 March 2005