Laparoscopic left lateral hepatic lobectomy: a safer and faster technique.
ABSTRACT Laparoscopy for liver resection is highly specialized field because laparoscopic liver surgery presents severe technical difficulties, such as control of bleeding and risk of gas embolism. At present, a limited number of laparoscopic anatomical left lobectomies have been reported in the literature, but we believe that the use of stapling devices has made this technique safer and faster.
From January 2000 to May 2005, eight patients (five men, three women; mean age, 60.5 years) underwent laparoscopic anatomical left lobectomy at our department. Seven patients presented with hepatocellular carcinoma and cirrhosis, while one patient had a large symptomatic angioma. The average size of the lesions was 4.18 cm (range, 3.6-7.1 cm); all the lesions were localized in the anatomical left lobe (segments II-III). Transection of the liver parenchyma, together with sectioning of the vascular pedicle for segment II and III and of the left hepatic vein, was obtained by the use of stapling devices.
The mean operative time was 142 min (range, 120-180 min). There were no intraoperative or postoperative complications, and blood transfusions were not required. The mean postoperative hospital stay was 5.75 days.
The key points of the technique are: late mobilization of the liver; no transection of the round ligament; no surrounding or taping of the portal pedicles or of the left hepatic vein; and the use of three consecutive linear staplers, turned to the left for transecting the liver parenchyma and vascular pedicle together. This technique, in our opinion, should be considered a new good option for patients with isolated lesions of the left lateral segments, but it must be performed by surgeons trained in both liver and advanced laparoscopic surgery.
Article: Intrahepatic Glissonian Approach for Laparoscopic Left Lateral Segmentectomy: Is it Worthwhile? Report on Six Cases Intrahepatic Glissonian Approach for Laparoscopic Left Lateral Segmentectomy: Is it Worthwhile? Report on Six Cases O Acesso Glissoniano Intra-Hepático para Segmentectomia Lateral Esquerda Laparoscópica: Ele Vale a Pena? Relato de Seis Casos Operados[Show abstract] [Hide abstract]
ABSTRACT: Background: Laparoscopic resection is considered the gold-standard approach for both benign and malignant neoplasms that arise in left hepatic lobe. Laparoscopic left lateral segmentectomy (LLLS) by means of an intrahepatic approach has emerged as an interesting alternative because it is fast and easy to perform and is associated with infrequent intraoperative bleeding. Aim: To report on a series of six patients who underwent LLLS by means of an intrahepatic Glissonian approach (IHGA) performed by a single surgical team at Santa Lucia Hospital, Brasilia, Federal District, Brazil. Patients and Methods: Six patients underwent LLLS between January 2009 and June 2011. The median age was 41 (range: 21 to 53 years). There were four women and two men. The etiologies of the lesions were: focal nodular hyperplasia (n=2), giant hemangioma (n=1) and metastasis (n=3). The mean lesion diameter was 4.6 cm (range 1.8 -12 cm). Results: The mean duration of the procedure was 140 minutes (range 100-200 minutes). Mean intraoperative blood loss was 150 ml (range 50-600 ml). There was no mortality and the morbidity rate was 15%. The median hospital stay was three days (range 2-7 days). The median length of time taken to return to day-to-day activities was 12 days (range 7-30 days). Conclusion: LLLS by means of an intrahepatic Glissonian approach (IHGA) should be considered to be a good option for treating hepatic tumors located in the left hepatic lobe. This approach provides a safe and fast option that avoids large blood loss.Brazilian Journal of Videoendoscopic Surgery. 12/2011; 4(1983-9901-4):217-223.
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ABSTRACT: The present study was undertaken to determine whether laparoscopic live donor left lateral sectionectomy (LLS) in paediatric liver transplantation is a feasible, safe and reproducible procedure, compared with open live donor left lateral sectionectomy (OLS). A retrospective review was conducted of all consecutive live donor procedures for paediatric liver transplantation performed between May 2008 and October 2009. All live donor hepatectomies were carried out by a single surgeon. A total of 26 live donor procedures for paediatric liver transplantation were performed, of which 11 were LLS and 11 OLS; four left hepatectomies were excluded. The LLS group had a significantly shorter hospital stay (mean(s.d.) 6·9(0·3) versus 9·8(0·9) days; P = 0·001) and time to oral diet (2·1(0·3) versus 2·7(0·4) days; P = 0·012). Duration of operation, blood loss, warm ischaemia time and out-of-pocket medical costs were comparable between groups. There was no death in either donor group and only one complication, a wound seroma, in the OLS group. LLS seemed to be a safe, feasible and reproducible procedure, and was associated with reduced hospital stay.British Journal of Surgery 06/2011; 98(9):1302-8. · 4.84 Impact Factor
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ABSTRACT: BACKGROUND: Left lateral sectionectomy (LLS) is the most common type of anatomic laparoscopic liver resection performed, accounting for 20 % of all laparoscopic hepatectomies. Because there has been no standardized surgical technique for laparoscopic left lateral sectionectomy (LLLS), we offer an established operation: laparoscopically stapled left lateral sectionectomy (LSLLS). Our aim was to perform a case-controlled study of LSLLS with traditional (without vascular staplers) laparoscopic left lateral sectionectomy (TLLLS), validating the standardization and reproducibility of LSLLS. METHODS: From February 2009 to December 2011, a total of 49 LSLLSs were performed. The results were compared with 33 cohort-matched TLLLSs from an earlier time period. Ordered sample cluster analysis was used to determine the learning curve of LSLLS based on the operating time and blood loss. RESULTS : All LSLLS were performed successfully. There were no conversions to laparotomy or hand-assisted laparoscopic resection. Two endoscopic linear staplers were used in each case. Despite a higher hospital cost ($10,892 ± $944 vs. $8,962 ± $943, p < 0.05), LSLLS compared favorably with TLLLS regarding operating time (103 ± 21 vs. 151 ± 32 min, p < 0.05) and blood loss (70.8 ± 41.6 vs. 173.3 ± 131.1 ml, p < 0.05). No specific complications related to laparoscopy were observed. Ordered sample cluster analysis demonstrated a learning curve of 18 cases for LSLLS. CONCLUSIONS: This study demonstrates the standardization and reproducibility of LSLLS. We therefore propose LSLLS as the standard technique for lesions located in the left lateral section of the liver.World Journal of Surgery 01/2013; · 2.23 Impact Factor