Totally laparoscopic anatomical liver resection for centrally located tumors: A single center experience

Wan-Joon Kim, Ki-Hun Kim, Min-Ho Shin, Young-In Yoon, Sung-Gyu Lee, Wan-Joon Kim, Ki-Hun Kim, Min-Ho Shin, Young-In Yoon, Sung-Gyu Lee

Abstract

Laparoscopic major hepatectomy is a common procedure that has been reported frequently; however, laparoscopic resection of centrally located tumors involving segments 4, 5, and 8 remains a technically difficult procedure because it requires 2 transection planes and dissection of numerous branches of the hepatic vein and glissonean capsule compared to hemi-hepatectomy. Here, we present 7 cases of totally laparoscopic right anterior sectionectomy (Lap-RAS) and 3 cases of totally laparoscopic central bisectionectomy (Lap-CBS).Between May 2013 and January 2015, 10 totally laparoscopic anatomical resections of centrally located tumors were performed in our institution. The median age of the patients was 54.2 (38-72) years and the median ICG-R15 was 10.4 (3.9-17.4). There were 8 patients with hepatocellular carcinoma (HCC) and 2 with metastatic colorectal cancer. All the HCC patients has the liver function impairment on the degree of Child-Pugh score A.The mean operation time was 330 ± 92.7 minutes with an estimated blood loss of 325 ± 234.5 mL. Only 1 patient required transfusion during surgery. Mean postoperative hospital stay was 9.5 ± 3.4 day and postop complication was reported only 1 case that has the fluid collection at the resection margin of the liver. Mean resection margin was 8.5 ± 6.1 mm and tumor size was 2.9 ± 1.9 cm.Totally lap-RAS and lap-CBS are feasible operative procedures in patients with centrally located tumor of the liver and particularly in patients with limited liver function such as those with cirrhosis.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Location of trochar.
Figure 2
Figure 2
Intraoperative views of the major steps on total laparoscopic anterior sectionectomy. (A) Right anterior glisson was isolated using the nylon tape. (B) In the case of CBS, the middle hepatic vein was divided using a vascular endoscopic stapler. (C) Right anteriorglisson was divided using a vascular endoscopic stapler. (D) Laparoscopic view after completion of a right anterior sectionectomy. CBS = centralbisectionectomy, RHV = right hepatic vein, MHV = middle hepatic vein.

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