Our first laparoscopic right hepatectomy. A challenge for a surgical team

Abstract

Background: In our group we decided to face this difficult procedure after having performed resection in all hepatic segments, including the demanding segment VII. Methods: We present the case of a young woman, 22 years old, who presented a liver mass, 70 mm in diameter, atypical characteristics in diagnostic procedures (CT, MR)and that showed hipermetabolic activity in CT-PET suggesting malignancy. The patients was placed in a supine position with legs open and partial elevation of the right chest and abdomen. Five trocars were used and a extracorporeal tourniquet was prepared using a 20 Fr thoracic drain. Surgical steps were: 1) right liver mobilization; 2)place of a textil tape around the hepatic hilum for Pringle manoeuver if necessary; 3) dissection and section of cystic artery and duct; 4) hilar dissection with control and section of right hepatic artery and right portal vein; 5)completion of cholecystectomy; 6) parenquimal transection, section of right hepatic duct with stapler and final section of the right hepatic vein with a vascular stapler. A midline incision was performed for the extraction of the specimen an a drain was left in place. Results: No Pringle manoeuver was used. Intraoperative bleeding was 500 ml. No transfusion was necessary. The postoperative course was uneventful, with a postoperative stay of 5 days. Conclusion: Right laparoscopic hepatectomy is a demanding procedure. Strict criteria of selection of patients should be applied in the early experience of the surgical teams in order to face this procedure.