Laennec\u2019s approach for laparoscopic anatomical hemihepatectomy

Wei Hu,Gongming Zhang,Mingxu Li,Kai Li,Chengcheng Zhong,Xitai Sun,Meng Chen,Zhong Wang

doi:10.1186/s12957-021-02404-1

Abstract

BackgroundLaennec’s capsule has been found for about 200 years. However, laparoscopic anatomical right and left hemihepatectomy (LARH and LALH) using Laennec’s approach are rarely reported.MethodsWe retrospectively analyzed the technical details and the surgical outcomes of 15 patients who underwent LAH via Laennec’s approach between May 2017 and July 2020. The operation time, intraoperative blood loss, postoperative complications, and hospital stay were recorded and analyzed.ResultsFour of 15 patients were diagnosed with hepatic hemangioma, 2 had hepatolithiasis, and 9 patients had primary liver cancer. During the surgery, Laennec’s approach was used for LAH without conversion to open surgery. Four patients were treated with LARH, and 11 patients were cured with LALH. The mean age of the patients was 62.1 ± 6.5 years, and four were male. The mean operative time, blood loss, and length of the postoperative hospital stay were 193 ± 49 min, 247 ± 120 mL, and 8.7 ± 2.0 days, respectively. There was no incidence of postoperative bile leakage and bleeding. No mortality occurred. We also demonstrated that Laennec’s capsule does exist around the peripheral hepatic veins with histological confirmation.ConclusionsLaennec’s approach is safe and feasible for LAH. Precise isolation of Laennec’s approach based on Laennec’s capsule helps to standardize the surgical techniques for laparoscopic anatomical hepatectomy.

Highlights

Laparoscopic liver surgery, a widely accepted standard surgical practice for the management of liver neoplasm, has evolved over the past two decades, and the procedure has expanded from initial local hepatectomy to anatomical hepatectomy
We retrospectively analyzed the technical details and the surgical outcomes of our standardized approach performed on 15 patients who underwent laparoscopic anatomical hemihepatectomies (LAH) in our hospital between May 2017 and July 2020
The liver tissue specimens adjacent to the Glissonean pedicle (GP), hepatic veins, and inferior vena cava (IVC) were collected for hematoxylin and eosin (H&E) and Mallory’s phosphotungstic acid hematoxylin-eosin staining

Summary

Introduction

Laparoscopic liver surgery, a widely accepted standard surgical practice for the management of liver neoplasm, has evolved over the past two decades, and the procedure has expanded from initial local hepatectomy to anatomical hepatectomy. Laennec’s capsule, the liver’s intrinsic membrane, represents an essential structure for the comprehensive understanding of the surgical anatomy of the liver and. LAH based on Laennec’s capsule is rarely reported. We described the relevant application of Laennec’s approach for LAH based on Laennec’s capsule and highlighted the surgical anatomical description of the liver and related clinical experience. We investigated the safety and efficacy of this approach to expand our understanding of the membranous anatomy of the liver. Laparoscopic anatomical right and left hemihepatectomy (LARH and LALH) using Laennec’s approach are rarely reported

Methods

Results

Discussion

Conclusion