Laparoscopic Non Anatomical Hepatectomy

Abstract

Introduction: Despite advances in field of energy devices and surgical techniques, Performing Hepatectomy is still considered a difficult task. Anatomical Hepatectomy is further difficult compared to Non-Anatomical Hepatectomy. Apart from Inflow Outflow Control & Parenchymal Transection, which are challenges even in Conventional Open Hepatectomy, Laparoscopic Hepatectomy has additional challenges of 1)Risk of massive air embolism during vascular dissection 2)Difficult ergonomics & 3)Accessibility issues. So Anatomical Laparoscopic Hepatectomy is considered a pinnacle . Due to these reasons laparoscopic hepatectomy is facing stiff resistance in making progress by leaps & bounds on par with rest of the laparoscopic procedures. Anatomical Laparoscopic Hepatectomy, though challenging, can be performed in a few select cases. But, in certain benign indications such as hydatid cysts, cystic neoplasms & some hemangiomas, Laparoscopic Non-Anatomical Hepatectomy can avoid large incisions like right subcostal(Kocher’s), bilateral subcostal (Roof-top), Makuchi, Seagull, etc., thereby reducing morbidity due to pain & lung complications with early return to work. Also, Non-Anatomical Hepatectomy is technically easier to perform than Anatomical Hepatectomy, as we can avoid critical steps such as inflow & outflow control. Method: We present a series of 5 cases, which include 2 Right & 3 Left Non-Anatomical Hepatectomies which were done for 3 patients with Hydatid Cysts (2 in left lobe & 1 in right lobe) & 2 Benign cystic neoplasm (1 in left lobe & 1 in right lobe). We present a video of laparoscopic left and right hepatectomy. Result: All patients were discharged with Mean length of hospital stay 2.5 days, Intra-operative blood loss less than 500 ml, Nil port site compilations, Mean pain score 2.8, Nil required drain placement, Nil required re-exploration/resurgery. Conclusion: Hence, small, benign, peripheral located, less vascular lesions can be managed with Laparoscopic Non-Anatomical Hepatectomy,with small incision, good cosmesis, less risks, and less morbidity.