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.
Article: Evolution of laparoscopic left lateral sectionectomy without the Pringle maneuver: through resection of benign and malignant tumors to living liver donation.[show abstract] [hide abstract]
ABSTRACT: Laparoscopic left lateral sectionectomy (LLS) has gained popularity in its use for benign and malignant tumors. This report describes the evolution of the authors' experience using laparoscopic LLS for different indications including living liver donation. Between January 2004 and January 2009, 37 consecutive patients underwent laparoscopic LLS for benign, primary, and metastatic liver diseases, and for one case of living liver donation. Resection of malignant tumors was indicated for 19 (51%) of the 37 patients. All but three patients (deceased due to metastatic cancer disease) are alive and well after a median follow-up period of 20 months (range, 8-46 months). Liver cell adenomas (72%) were the main indication among benign tumors, and colorectal liver metastases (84%) were the first indication of malignancy. One case of live liver donation was performed. Whereas 16 patients (43%) had undergone a previous abdominal surgery, 3 patients (8%) had LLS combined with bowel resection. The median operation time was of 195 min (range, 115-300 min), and the median blood loss was of 50 ml (range, 0-500 ml). Mild to severe steatosis was noted in 7 patients (19%) and aspecific portal inflammation in 11 patients (30%). A median free margin of 5 mm (range, 5-27 mm) was achieved for all cancer patients. The overall recurrence rate for colorectal liver metastases was of 44% (7 patients), but none recurred at the surgical margin. No conversion to laparotomy was recorded, and the overall morbidity rate was 8.1% (1 grade 1 and 2 grade 2 complications). The median hospital stay was 6 days (range, 2-10 days). Laparoscopic LLS without portal clamping can be performed safely for cases of benign and malignant liver disease with minimal blood loss and overall morbidity, free resection margins, and a favorable outcome. As the ultimate step of the learning curve, laparoscopic LLS could be routinely proposed, potentially increasing the donor pool for living-related liver transplantation.Surgical Endoscopy 01/2011; 25(1):79-87. · 4.01 Impact Factor