Tips for junior HBP surgeon to perform laparoscopic anatomic S3 hepatectomy in a regional hospital

Abstract

Summary: Purpose: Laparoscopic anatomic hepatectomy is an advanced procedure for HBP surgeons, and most junior HBP surgeons would perform laparoscopic left lateral segmentectomy or wedge resection as their initial experience for laparoscopic hepatectomy. Miaoli General Hospital is a regional hospital in alliance with Far-Eastern Memorial Hospital, and it provides surgical service majorly laparoscopic appendectomy, cholecystectomy or colectomy. Laparoscopic anatomic hepatectomy had never been performed in this hospital before, and some special devices for laparoscopic hepatectomy, such as laparoscopic ultrasound transducer or CUSA, are not available. This video would present a junior HBP surgeon to perform laparoscopic anatomic hepatectomy for hepatocellular carcinoma (HCC) at S3. Materials and Methods: A 78-year-old man, an HBV carrier, was diagnosed with a new hepatic nodule at lateral segment of liver under routine sonographic survey. Further abdominal CT and MR scan showed a solitary 1.9cm HCC at S3. As ICG test was not available in this hospital, laparoscopic anatomic S3 hepatectomy was indicated for this elderly patient with Child A cirrhosis, attempt to preserve normal liver parenchyma as much as possible. Results: Total operation time was 186 minutes, and blood loss was about 70ml. The intracorporeal Pringle maneuver was prepared with Fr. 16 foley catheter (Huang’s loop) but never applied during hepatectomy. Harmonic scalpel and monopolar coagulation were the major energy devices during hepatectomy. The patient had uneventful postoperative course and was discharged 7 days after operation. The final pathology report showed well differentiated HCC, pT1b, without margin, perineural or lymphovascular invasion. Conclusion: Laparoscopic anatomic hepatectomy is possible for junior HBP surgeons to do in a resource-limited hospital with basic energy devices and easy inflow control method. However, the operators should prepare to gain experience in hepatectomy during residency, observe plenty live laparoscopic hepatectomies and participate in hand-on laparoscopic skill workshop.