Pure laparoscopic hepatectomy in semiprone position for right hepatic major resection
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TOPICS
Laparoscopic major liver resection
Pure laparoscopic hepatectomy in semiprone position for right hepatic major resection Tetsuo Ikeda • Yohei Mano • Kazutoyo Morita • Naotaka Hashimoto • Hirohito Kayashima • Atsuro Masuda • Toru Ikegami • Tomoharu Yoshizumi Ken Shirabe • Yoshihiko Maehara
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Published online: 2 October 2012 Ó The Author(s) 2012. This article is published with open access at Springerlink.com
Abstract Background Pure laparoscopic liver resection is technically difficult for tumors located in the dorsal anterior and posterior sectors. We have developed a maneuver to perform pure laparoscopic hepatectomy in the semiprone position which was developed for resecting tumors located in these areas. Methods The medical records have been reviewed retrospectively in 30 patients who underwent laparoscopic liver resection in the semiprone position for carcinoma in the dorsal anterior or posterior sectors of the right liver between 2008 and 2011. Results Seventeen liver tumors were primary liver tumors and 13 were colorectal metastases. Of the 30 patients, 11 (36.6 %) underwent major hepatectomy [right hemihepatectomy in 7 (23.3 %) and posterior sectionectomy in 4 (13.3 %)]. Anatomical minor resection, such as S6 or S7 segmentectomy, was performed in five patients (16.6 %). Five patients with liver metastasis underwent a simultaneous laparoscopic resection. There was no mortality, reoperation, or conversion to open procedures. There were no hepatectomy-related complications such as postoperative bleeding, bile leakage, or liver failure.
Electronic supplementary material The online version of this article (doi:10.1007/s00534-012-0558-y) contains supplementary material, which is available to authorized users. T. Ikeda (&) Y. Mano K. Morita N. Hashimoto H. Kayashima A. Masuda T. Ikegami T. Yoshizumi K. Shirabe Y. Maehara Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan e-mail: [email protected]
Conclusions Pure laparoscopic hepatectomy in the semiprone position for tumors present in the dorsal anterior and posterior sectors is feasible and safe. This method expands the indications for laparoscopic liver resection for tumors. Keywords Pure laparoscopic hepatectomy Semiprone position Anatomical liver resection Rouviere’s sulcus
Introduction In November 1994, laparoscopic hepatectomy was introduced to our institution on the principle that parenchymal division would be performed under direct vision through a small laparotomy wound. In 1996, pure laparoscopic partial hepatectomy with parenchymal division using a linear stapler was also introduced. In June 2008, pure laparoscopic hepatectomy (PLH) involving hepatic parenchymal division of most of the liver was performed with a TissueLink Monopolar Sealer (TL-MS; Endo SH2.0TM sealing hook) and a laparoscopic Cavitron ultrasonic dissector (CUSA; Radionics, Burlington, MA, USA). First, the liver parenchyma was coagulated with the TL
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