7105 Laparoscopic hepatectomy for liver tumor as a new surgical alternative.

Abstract

The development of laparoscopic hepatectomy has been impeded by unsolved technical difficulties. However, a variety of laparoscopic instruments and devices have been developed, leading us to establish laparoscopic hepatectomy. Results of a clinical series of 23 patients are reported. Surgical procedure: A microwave tissue coagulator was used in combination with an ultrasonic surgical aspirator or a laparoscopic coagulating shears to divide hepatic parenchyma by using abdominal wall lift without pneumoperitoneum. Branched vessels and ducts were clipped and transected. The endoscopic linear stapler was used to transect the Glisson's pedicle and left hepatic vein. Patients: The indications were hepatocellular carcinoma in 12 cases, isolated metastatic tumor in 4 cases, hemangioma in 4 cases, others in 3 cases. The underlying liver diseases was liver cirrhosis in 9 cases and chronic hepatitis in 5 cases. Result: Six patients underwent left lateral segmentectomy and seventeen patients underwent partial hepatectomy. The 22 procedures were performed safely. There were notable difference in blood loss and operating time compared with open hepatectomy. No postoperative complication including no bile leakage and abscess, except ascitis and pneumonia in one case was observed. The postoperative recovery such as oral intake and ambulatory was faster and pain was minimal. Indication: The preoperative assessment of liver function for laparoscopic and open hepatectomy is the same. Tumors smaller than 5 cm, and nodular types, especially extrahepatic growth types, are the best candidates for laparoscopic resection. Concerning location, tumors in the lower segment and left lateral segment were good indication. Conclusion: The laparoscopic hepatectomy, especially partial or left lateral segmentectomy, appears to be a viable surgical alternative in selected patients as minimal invasive surgery.