Laparoscopic left hepatectomy exposing the middle hepatic vein

Abstract

Presenter: Jaime Kruger MD | Hospital das Clinicas - University of Sao Paulo Background: Laparoscopic liver resections are being increasingly performed in tertiary specialized HPB centers. Lesions close to major vessels were considered a contraindication for minimally invasive operations, but with progressive technical development such operations can be performed safely offering patients the benefits of laparoscopic approach. Methods: Video describing technique for a totally laparoscopic left hepatectomy. A 65 years-old female patient presented with epigastric pain. Abdominal MRI revealed a complex cystic mass on the central portions of the left lobe suggesting a mucinous biliary neoplasia. The lesion had a close contact with the middle hepatic vein along most of its extension. Due to the importance of venous drainage on postoperative liver function a laparoscopic left hepatectomy preserving the middle hepatic vein was planned. Five ports were placed and a 10 mm 30 degree scope was employed. Transection was carried out with ultrasonic scalpel under pneumoperitoneum pressure of 12 mmHg. Results: Operative time was 150 minutes and estimated blood loss was 120 mL. Patient recovered uneventfully and was discharged from hospital on the 4th POD. Pathology report confirmed a benign mucinous biliary neoplasia (former biliary cystadenoma) without areas of suspected displasia or malignant transformation. Conclusion: Liver resection in large lesions located along major vessels is feasible and should be performed in centers with expertise in laparoscopic liver resection. Preserving adequate liver remnant venous drainage might result in better postoperative function reducing complications.