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.

Coding recommendations

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

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.