Laparoscopic Anatomical Hepatectomy Research Articles

Intrahepatic Glissonean Pedicle Approach to Segment 7 from the Dorsal Side During Laparoscopic Anatomic Hepatectomy of the Cranial Part of the Right Liver

Intrahepatic Glissonean Pedicle Approach to Segment 7 from the Dorsal Side During Laparoscopic Anatomic Hepatectomy of the Cranial Part of the Right Liver

Perioperative and oncological outcomes of laparoscopic anatomical hepatectomy for hepatocellular carcinoma introduced gradually in a single center.

Anatomical hepatectomy is an ideal curative treatment for hepatocellular carcinoma (HCC). We have standardized our laparoscopic anatomical hepatectomy (LAH) procedure, gradually extending its indications. In the present study, we describe our experience and the perioperative and oncological outcomes of LAH for HCC compared to those of open anatomical hepatectomy (OAH) during the gradual introduction of LAH. Seventy patients with primary HCC underwent anatomical hepatectomy in our institution from November 2008 to April 2014. As we gained experience with LAH, our indications for choosing LAH over OAH gradually expanded. Ultimately, 40 and 30 patients underwent LAH and OAH, respectively. Perioperative and oncological outcomes were compared between the two groups. There were no significant differences in age, sex, background of liver disease, liver function, tumor size, tumor number, or type of liver resection between the two groups. Major complications and mortality rates were similar between the LAH and OAH groups (12.5% vs. 20%; p=0.582, and 0% vs. 3.3%; p=0.429, respectively). The median follow-up time after surgery was 40.5months in the LAH group and 32.9months in the OAH group (p=0.835). The 1-, 3-, and 5-year overall survival rates were 89.9, 84.7, and 70.9%, in the LAH group, and 89.8, 68.0, and 63.1% in the OAH group, respectively (p=0.255). The 1-, 3-, and 5-year disease-free survival rates were 79.5, 58.0, and 42.5%, in the LAH group, and 72.4, 56.1, and 50.4% in the OAH group, respectively (p=0.980). Through gradual introduction of LAH, we obtained comparable results to those achieved with OAH. LAH can be a feasible surgical treatment for primary HCC, with good oncological outcomes.

Laparoscopic anatomical segmentectomy of liver segments VII and VIII with the hepatic veins exposed from the head side (with videos).

The reported protocol was difficult to expose the hepatic veins for laparoscopic anatomical hepatectomy of segments VII and VIII. We introduce a new, convenient, applicable approach with the hepatic vein exposed from the head side. This study included 10 patients who underwent laparoscopic liver resection for HCC in the segments VII and VIII between October, 2014 and November, 2015. Their perioperative course and operative techniques were retrospectively evaluated. All patients underwent laparoscopic anatomical segmentectomy of segments VII and/or VIII of the liver with the hepatic vein exposed from the head side. None of the cases was converted to open surgery. The average procedure duration was 326.20 ± 51.13 min, and the average blood loss volume was 375.0 ± 166.42 ml. No postoperative complications were observed. The average postoperative hospital stay was 6.7 ± 0.82 days. No recurrence or metastasis was observed. Laparoscopic anatomical segmentectomy of liver segments VII and VIII, with the hepatic vein exposed from the head side, may be safe, convenient, and applicable to perform. J. Surg. Oncol. 2016;114:752-756. © 2016 Wiley Periodicals, Inc.

Clinical analysis laparoscopic anatomical hepatectomy

Objective To evaluate the feasibility and efficacy of laparoscopic anatomical hepatectomy. Methods The clinical data of 60 patients who underwent laparoscopic hepatectomy from October 2013 to May 2015 were retrospectively analyzed. Results Two patients required conversion to laparotomy. Laparoscopic anatomical hepatectomy was carried out in 40 patients, including 6 with right hemihepatectomy, 10 with left hemihepatectomy, 2 with caudate lobe resection, 2 with right posterior sectionectomy, 15 with left lateral sectionectomy, 3 with segment Ⅴ resection and 2 with segment Ⅵ resection. The other 20 patients had laparoscopic nonantomical hepatectomy. The operative time was (210±20)min, the bleeding volume was (320±140)ml, and the duration of hospitalization was (10±2)days. There were no serious postoperative complications. All patients had the first flatus passed between 24 to 72 hours after operation. There was no operative death. On follow-up for 50 patients from 1 to 19 months after surgery, no recurrence was found in 36 malignant liver tumor patients except in 3 patients who were operated for hepatocellular carcinoma. Conclusion Laparoscopic anatomic hepatotectomy is a feasible and efficacious option for liver resection to treat liver diseases. Key words: Liver resection; Anatomy; Laparoscopy

Application of hemi-hepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy

Objective To explore the application value of hemi-hepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy. Methods The clinical data of 15 patients who underwent laparoscopic anatomic hepatectomy by hemi-hepatic blood flow occlusion using descending hilar plate technique at the First People's hospital of Foshan between August 2012 and May 2014 were retrospectively analyzed. The hilar plate was bluntly dissected to expose the left and right Glissonean pedicles. Either side of Glissonean pedicle was tied up with a turnable aspirator with a cotton rope or shoelace and then bypassed the back of hilar plate. Anatomic hepatectomy was performed when hemi-hepatic blood flow was occluded. The follow-up by telephone interview and outpatient examination was done till October 2014. Results Among the 15 patients, the conversion to open surgery was done in 1 patient, Pringle maneuver in 1 patient, and hemi-hepatic blood flow occlusion by descending the hilar plate in 14 patients. Thirteen patients received succesfully laparoscopic anatomic hepatectomy by hemi-hepatic blood flow occlusion using descending hilar plate technique, including 4 of left hemihepatectomy, 4 of left lateral lobectomy, 2 of right hemihepatectomy, 1 of right posterior lobectomy, 1 of segment Ⅳ hepatectomy and 1 of segment Ⅵ hepatectomy. Bile duct exploration was applied to 4 patients with left hepatic duct stones and T-tube was placed in 2 patients. Nine and 4 patients received left and right hemi-hepatic blood flow occlusion, respectively. The operation time, mean volume of intraoperative blood loss and time of hemi-hepatic blood flow occlusion in 13 patients were (196±63) minutes, 320 mL(range, 50-1 200 mL) and (51±20) minutes, respectively. The time of descending the hilar plate in 14 patients was (10±4) minutes. Among the 13 patients, bile leakage was detected in 1 patient with a maximum volume of drainage of 120 mL/ day, liver wound bleeding in 1 patient with a volume of abdominal bloodstained drainage of 400 mL at postoperative day 2. Two patients were cured by conservative treatment, and no liver failure and perioperative death were occurred. The duration of hospital stay was (6.9 ± 2.4) days. Among the 15 patients, 2 patients were loss to follow-up and other patients were followed up for 5-26 months with good survival, 1 patient died. Conclusion Hemi-hepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy is safe and feasible. Key words: Liver neoplasms; Laparoscopy; Hemi-hepatic blood flow occlusion; Descending hilar plate; Hepatectomy

Clinical efficacy of laparoscopic anatomical hepatectomy via Glissonean pedicle transection approach

Objective To investigate the clinical efficacy of laparoscopic anatomical hepatectomy via Glissonean pedicle transection approach. Methods The clinical data of 68 patients who underwent laparoscopic anatomical hepatectomy by Glissonean pedicle transection approach at the Southwest Hospital of Third Military Medical University between March 2009 and December 2013 were retrospectively analyzed. All the patients received intravenous-inhalation general anesthesia. The splitting of liver was carried out after Glissonean pedicles were completely dissected and occluded under the laparoscope according to anatomical structure. The patients with hepatolithiasis underwent intraoperative bile duct exploration and stone removal with T-tube placement based on the conditions of extrahepatic biliary lesions. The fragmented specimens from benign lesions of liver were taken out through a Trocar hole with the diameter of 12mm. The complete specimens from malignancy tumors of liver were taken out through an enlarged Trocar hole or transverse incision at the symphysis pubis. According to the recheck results of benign and malignancy lesions, the patients were followed up by outpatient examination and telephone interview till September 2014. The measurement data with normal distribution were presented as ±s. The survival curve was drawn by Kaplan-Meier method. Results Among the 68 patients, laparoscopic anatomical hepatectomy via Glissonean pedicle transection approach was performed on 64 patients and 4 patients were coverted to open surgery. Laparoscopic anatomical left hemihepatectomy was performed on 30 patients, anatomical right hemihepatectomy on 19 patients, anatomical right posterior lobectomy on 10 patients and anatomical right anterior lobectomy on 9 patients. The mean operation time, volume of intraoperative blood loss, rate of perioperative blood transfusion, time of postoperative gastrointestinal function recovery and duration of hospital stay were (224±117) minutes, (413±349) mL, 5. 9% (4/ 68) , (3. 0±0. 5) days and (8. 0±3. 0) days, respectively. There was no perioperative death, and 6 patients with postoperative complication were cured by symptomatic treatment. The tumor diameter and distance to resection margin in 29 patients with malignancy tumors of liver were (4. 4 ± 1.6) cm and (2. 0±0.9) cm, respectively. The results of pathological examination showed that hepatolithiasis was detected in 22 patients, cavernous hemangioma of liver in 12 patients, hepatic focal nodular hyperplasia in 1 patient, hepatic adenoma in 1 patient, hepatic angiomyolipoma in 1 patient, hepatic multiple cysts in 1 patient, hepatic tuberculosis in 1 patient, hepatocellular carcinoma in 27 patients and cholangiocarcinoma in 2 patients. All the 68 patients were followed up for 6-60 months with a mean time of 24 months. No recurrence and residual stones or lesions in 39 patients with benign lesions of liver were detected during the follow-up. The 1-, 3-, 5-year overall survival rates and tumor-free survival rates in 29 patients with malignant tumors of liver were 92% , 84% , 60% and 83% , 59% , 42% , respectively. Conclusion Laparoscopic anatomical hepatectomy via Glissonean pedicle transection approach is safe and feasible, and is suitable not only for left hemihepatectomy, but also for right hemihepatectomy of high technical specification. Key words: Liver neoplasms; Hepatolithiasis; Laparoscopy; Hepatectomy; Glissonean pedicle

Totally Laparoscopic Anatomical Hepatectomy Exposing the Major Hepatic Veins from the Root Side: a Case of the Right Anterior Sectorectomy (with Video)

Laparoscopic hepatectomy has rapidly evolved recently; 1-5 however, laparoscopic anatomical hepatectomy has yet to become widely used, although anatomical hepatectomy is ideal, especially for curative treatment of hepatocellular carcinoma, and is widely accepted via open approach. 6-10 This is because good-experienced skills, for example, exposing Glissonean pedicles and hepatic veins on the cutting plane, are required in order to perform anatomical hepatectomy via a pure laparoscopic approach. We obtained good results for various totally laparoscopic anatomical hepatectomies using the standardized techniques. We exposed the major hepatic veins from the root side by utilizing the unique view from the caudal side in the laparoscopic approach, and moved CUSA from the root side toward the peripheral side to avoid splitting the bifurcation of the hepatic vein. 11-13 We performed totally laparoscopic anatomical hepatectomy for 47 patients from August, 2008, to December, 2012 (Table 1). In most types of anatomical hepatectomy, the mean blood loss was <500 ml. Conversion to open surgery was required in two patients. Postoperative complications were prolonged ascites in two, peroneal palsy in two, and biloma in one. Mortality was zero. The embedded video demonstrates totally laparoscopic right anterior sectorectomy. In conclusion, our standardized techniques make laparoscopic anatomical hepatectomy more feasible.

Laparoscopic anatomical hepatectomy: a report on 40 patients

Objective To investigate the practicability and safety of laparoscopic anatomical hepatectomy.Method 40 patients with space occupying lesions in the liver underwent laparoscopic anatomical hepatectomy between Jan.2008 and Mar.2012.The diagnoses were hepatocellular carcinoma (HCC) (n=13),recurrent HCC (n =1 ),cholangiocarcinoma ( n =1 ),metastatic cancer ( n=6),hepatolithiasis (n=10),hemangioma (n=7),FNH (n=1) and liver cell adenoma (n =1).Intraoperative ultrasound was routinely performed to locate lesions and intrahepatic structures.Selective hemihepatic vascular occlusion was applied during resection. High frequency cautery,CUSA and Ligasure were used to transect liver parenchyma. Hemolocks were applied when large blood vessels and bile ducts were encountered.Endo-GIA was used if necessary.The operations included right hemihepatectomy (n =3),left hemihepatectomy (n =10),resections of segment Ⅴ and Ⅵ (n=5),segment Ⅴ (n=3),segment Ⅵ (n =4),and segment Ⅳb (n =1).Result 34 hepatectomics were performed laparoscopically.6 patients were converted to open surgery.There was no perioperative death. The operating time was 250.21±50.94 min,and intraoperative blood loss was 420.20± 120.10 ml.Bile leakage was diagnosed in 2 patients after operation.Conclusion With careful patient selection,and improvement in surgical technique and apparatus,laparoscopic anatomical hepatectomy has become safe and practicable.The operation has the advantages of minimal invasion and rapid recovery. It can be regarded as a standard procedure for selected benign and malignant lesions. Key words: Laparoscopy; Anatomical Hepatectomy

Intraoperative nursing cooperation for robotic-assisted laparoscopic precise liver resection

Objective To investigate intraoperative nursing cooperation for robotic-assisted laparoscopic precise liver resection. Methods Between April and July 2009, 13 consecutive patients underwent roboticassisted laparoscopic anatomic hepatectomy for benign and malignant hepatic diseases. The clinical data of preoperative preparation, intraoperative cooperation and management of emergency were analyzed retrospectively and summarized gradually. Results All 13 robotic-assisted laparoscopic precise liver resections were performed successfully in the manner of pure laparoscopic resection. The nursing protocol was formulated to improve the preoperative preparation, intraoperative cooperation, management of emergency and postoperative summary. The nursing outcome was satisfactory due to effective nursing strategy. Conclusions Robotic surgery has been expanded into multi-disciplinary field, therefore preparation, communication, discreet placement and protection are important guarantees in its development. Key words: Robot; Intraoperative care; Precise liver resection

Robotic-Assisted Laparoscopic Anatomic Hepatectomy in China

To assess the feasibility and safety of robotic-assisted laparoscopic anatomic hepatectomy. The development of minimally invasive surgery has led to an increase in the use of laparoscopic hepatectomy. However, laparoscopic hepatectomy remains technically challenging and is not widely developed. Robotic surgery represents a recent evolution in minimally invasive surgery that is being used increasingly for complex minimally invasive surgical procedures. Herein, we report our initial experience with robotic-assisted laparoscopic anatomic hepatectomy in 13 consecutive patients. Between April and July 2009, 13 consecutive patients underwent robotic-assisted laparoscopic anatomic hepatectomies for benign and malignant hepatic diseases. Major hepatectomies were performed in 9 patients, left lateral sectionectomies in 4 patients. Eight major hepatectomies were for malignant diseases and 5 hepatectomies (1 left hepatectomy and 4 left lateral sectionectomies) were for benign diseases. All the robotic-assisted hepatectomy procedures were performed anatomically with hilum dissection. Prior to starting the parenchymal transaction, vascular control of the portal vessels was carried out whenever possible. These robotic-assisted laparoscopic anatomic hepatectomies were compared with 20 traditional laparoscopic hepatectomies and 32 open resections that were contemporaneous and cohort-matched. All 13 robotic-assisted laparoscopic anatomic hepatectomies were performed successfully in the manner of pure laparoscopic resection. No conversion to laparotomy or hand-assisted laparoscopic resection occurred. Despite its longer operative time (338 minutes) and higher hospital cost ($12,046), robotic liver surgery compared favorably with traditional laparoscopic hepatectomy and open resection in blood loss (280 vs. 350, 470 mL), transfusion requirement (0 vs. 3 of 20, 4 of 32), use of the Pringle maneuver (0 vs. 3 of 20, 6 of 32) and overall operative complications (7.8% vs. 10%,12.5%). Neither ascites nor transient hepatic decompensation occurred in the robotic group. The surgical margins in all 8 patients with malignant lesions were negative and as yet, no intrahepatic recurrences or metastases have been observed in the robotic group. The mean postoperative stay was shorter with the traditional laparoscopic procedure (5.2 days) than with robotic (6.7 days)or open surgery (9.6 days). Conversions from traditional laparoscopic to open and hand-assisted laparoscopic resection occurred in 2 patients (10.0%) who underwent right hemihepatectomy and left hepatectomy, respectively. These preliminary results show that robotic-assisted laparoscopic anatomic hepatectomy is safe and feasible with a much lower complication and conversion rate than traditional laparoscopic hepatectomy or open resection. The robotic surgical system may broaden the indications for laparoscopic hepatactomy, and it enabled the surgeon to perform precise laparoscopic liver resection which required hylum dissection, hepatocaval dissection, endoscopic suturing, and microanastamosis. However, more long-term, evidence-based outcomes will be necessary to prove its efficacy, and further research on its cost-effectiveness is still required.

Total laparoscopic anatomical hepatectomy for primary liver cancer: a report of 16 cases

Total laparoscopic anatomical hepatectomy for primary liver cancer: a report of 16 cases