Laparoscopic right hepatectomy with an anterior approach for large hepatocellular carcinoma using a right para caval liver hanging maneuver

Abstract

Introduction: Laparoscopic right hepatectomy (LRH) for large hepatocellular carcinoma (HCC) with an anterior approach is a complicated procedure. We gradually introduce a modified liver hanging maneuver (LHM) through the retrohepatic tunnel on the right side of the inferior vena cava with the assistant of a Goldfinger Dissector. Method: Between January 2012 and June 2018, 39 patients with large HCC underwent LRH were enrolled in this study. The first 27 patients did not apply the LHM technique (the non-LHM group); the following 12 patients implemented the LHM technique (the LHM group). Perioperative and survival outcomes were compared. Result: The preoperative variables were almost comparable between the two groups. The median tumor size was 12.0 (IQR 10.0-13.0) cm in the LHM group and 12.6 (IQR 9.9-15.0) cm in the non-LHM group (P=0.541). Ten patients (83.3%) in the LHM group and 20 (74.1%) in the non-LHM group had tumor size >10 cm (P=0.693). The median duration of retrohepatic dissection is 14.5 (IQR 12-16) minutes. Total blood loss was significantly greater in the non-LHM group than that in the LHM group (460 vs. 200 ml, P<0.001), especially during the procedure of hepatic parenchyma transection (300 vs. 100 ml, P<0.001). As a result, the operative time was longer (415 vs. 312 min, P<0.001), and intraoperative transfusion rate was higher (55.6% vs. 16.7%) in the non-LHM group than that in the LHM group. Two cases (7.4%) converted to an open approach in the non-LHM group, while no patients experience conversion in the LHM group (P=1.000). However, postoperative complications and long-term survival were comparable between the two groups. Conclusion: The LHM can be quickly established in the laparoscopic approach with the assistant a Goldfinger dissector through the retrohepatic tunnel on the right side of the inferior vena cava. Application of the LHM can increase the safety of LRH for large HCC.