Navigation Guidance Using Polyglycolic Acid Felt in Pure Laparoscopic Partial Hepatectomy.

Abstract

Appropriate determination of the dissecting plane for removing the tumor blood flow drainage area (TBF-D area) around a hepatocellular carcinoma as well as the tumor itself is essential in pure laparoscopic hepatectomy, but it is often difficult with the usual devices. Navigation technologies have been developed in an attempt to improve the technical accuracy, but they are still under development and cannot be easily applied yet in current clinical practice. To resolve this problem, we created a novel method of using absorbable polyglycolic acid felt (PGA felt) as a navigation guide in pure laparoscopic partial hepatectomy (PLH). We used a PGA felt cut into the appropriate shape in accordance with the shape determined preoperatively by simulation computed tomography in each case. We applied the felt on the surface of the liver intraoperatively as a guide for PLH. The PGA felt was placed on the surface of the liver, with the central portion of the felt aligned to the central portion of the tumor. The resection line was marked around the felt using monopolar electrocautery. Then, after removing the PGA felt, PLH was successfully performed along the marked line. The surgical margin was confirmed to be adequate in the resected specimen, which showed complete resection of the TBF-D area as well as of the tumor in a comparison with the preoperative computed tomography angiography images. This new technique is easy and safe and enables resection of both the tumor(s) and the TBF-D area appropriately and accurately in PLH.