Clinical efficacy of laparoscopic anatomical hepatectomy via Glissonean pedicle transection approach

Abstract

Objective To investigate the clinical efficacy of laparoscopic anatomical hepatectomy via Glissonean pedicle transection approach. Methods The clinical data of 68 patients who underwent laparoscopic anatomical hepatectomy by Glissonean pedicle transection approach at the Southwest Hospital of Third Military Medical University between March 2009 and December 2013 were retrospectively analyzed. All the patients received intravenous-inhalation general anesthesia. The splitting of liver was carried out after Glissonean pedicles were completely dissected and occluded under the laparoscope according to anatomical structure. The patients with hepatolithiasis underwent intraoperative bile duct exploration and stone removal with T-tube placement based on the conditions of extrahepatic biliary lesions. The fragmented specimens from benign lesions of liver were taken out through a Trocar hole with the diameter of 12mm. The complete specimens from malignancy tumors of liver were taken out through an enlarged Trocar hole or transverse incision at the symphysis pubis. According to the recheck results of benign and malignancy lesions, the patients were followed up by outpatient examination and telephone interview till September 2014. The measurement data with normal distribution were presented as ±s. The survival curve was drawn by Kaplan-Meier method. Results Among the 68 patients, laparoscopic anatomical hepatectomy via Glissonean pedicle transection approach was performed on 64 patients and 4 patients were coverted to open surgery. Laparoscopic anatomical left hemihepatectomy was performed on 30 patients, anatomical right hemihepatectomy on 19 patients, anatomical right posterior lobectomy on 10 patients and anatomical right anterior lobectomy on 9 patients. The mean operation time, volume of intraoperative blood loss, rate of perioperative blood transfusion, time of postoperative gastrointestinal function recovery and duration of hospital stay were (224±117) minutes, (413±349) mL, 5. 9% (4/ 68) , (3. 0±0. 5) days and (8. 0±3. 0) days, respectively. There was no perioperative death, and 6 patients with postoperative complication were cured by symptomatic treatment. The tumor diameter and distance to resection margin in 29 patients with malignancy tumors of liver were (4. 4 ± 1.6) cm and (2. 0±0.9) cm, respectively. The results of pathological examination showed that hepatolithiasis was detected in 22 patients, cavernous hemangioma of liver in 12 patients, hepatic focal nodular hyperplasia in 1 patient, hepatic adenoma in 1 patient, hepatic angiomyolipoma in 1 patient, hepatic multiple cysts in 1 patient, hepatic tuberculosis in 1 patient, hepatocellular carcinoma in 27 patients and cholangiocarcinoma in 2 patients. All the 68 patients were followed up for 6-60 months with a mean time of 24 months. No recurrence and residual stones or lesions in 39 patients with benign lesions of liver were detected during the follow-up. The 1-, 3-, 5-year overall survival rates and tumor-free survival rates in 29 patients with malignant tumors of liver were 92% , 84% , 60% and 83% , 59% , 42% , respectively. Conclusion Laparoscopic anatomical hepatectomy via Glissonean pedicle transection approach is safe and feasible, and is suitable not only for left hemihepatectomy, but also for right hemihepatectomy of high technical specification. Key words: Liver neoplasms; Hepatolithiasis; Laparoscopy; Hepatectomy; Glissonean pedicle