Pure Laparoscopic Left Hemihepatectomy Research Articles

A novel Laennec's capsule tunnel approach for pure laparoscopic left hemihepatectomy: a propensity score matching study.

With the development of laparoscopic hepatectomy, there are different surgical approaches and pedicle anatomical methods for laparoscopic left hepatectomy. Combined with our practical experience, we proposed a method of transhepatic Laennec membrane tunnel for laparoscopic left hemihepatectomy (LT-LLH) and investigated the feasibility by comparison with the extrahepatic Glissonian approach for laparoscopic left hemihepatectomy (GA-LLH). The data of patients who underwent laparoscopic left hepatectomy in the Department of Hepatobiliary Pancreatic surgery of Fujian Provincial Hospital from December 2019 to March 2022 were analyzed retrospectively. Among them, 45 cases underwent laparoscopic left hemihepatectomy with an extrahepatic Glissonian approach, and 38 cases underwent laparoscopic left hemihepatectomy via transhepatic Laennec membrane tunnel approach. A 1:1 propensity score matching (PSM) method was performed to compare the perioperative indexes and long-term tumor prognosis between the two groups. After 1:1 PSM, 33 patients in each group were selected for further analysis. Compared with the GA-LLH group, the operation time of the LT-LLH group was shorter. There was no significant difference in the incidence of total complications between the two groups. Moreover, no statistical differences were found in disease-free survival and overall survival between the two groups. It is safe, faster, and convenient for selective appropriate cases to carry out laparoscopic left hemihepatectomy through the hepatic Laennec membrane tunnel, which is suitable for clinical promotion.

Indocyanine green fluorescence-guided laparoscopic left hemihepatectomy: efficacy of negative staining for precise parenchymal transection and bile duct resection

Purpose: ICG fluorescence imaging is useful to locate segmental boundaries for anatomical resection and to delineate biliary anatomy. Its application in laparoscopic liver surgery is being recently explored and perceived of usefulness given the lack of tactile sensation. This video documents the application of the negative ICG staining technique for an efficient fluorescence guide in pure laparoscopic left hemihepatectomy, for both precise parenchymal transection and bile duct resection. Method: The patient is affected by solitary intrahepatic recurrence of colorectal liver metastasis between Sg 3 and 4 with endobiliary thrombus dilating the left hemiliver biliary tree. The hilar approach is used to isolate the left hepatic artery and ipsilateral portal branch, and the inflow for the left hemiliver is selectively clamped. A solution of 10 mg of ICG diluted in 10 mL saline solution is administered i.v. and the camera switched to the near infrared light. Results: After 2 mins the right hemiliver becomes fluorescent and left hemiliver counterstained on the glissonian surface. The proper transection line is marked, and the transection started. Differently from the traditional vascular demarcation, the ICG fluorescence boundary remains highly visible along the deep transection planes which allows to follow a clear and clean dissection plane during all the transection time. The transection is continued up to the hilar plate until the left portal branch and ipsilateral hepatic artery are encountered, which are both secured with clips before bulldog removal it is ensured that the left hemiliver remains unperfused by ICG, and the two vessels are then interrupted. The left bile duct is identified intraparenchymally, with the endobiliary thrombus inside remaining counterstained, and it is encircled distally to its endobiliary bulging thus allowing precise bile duct section with sufficient free margin at first frozen section. The transection is carried forward up to the identification of the left hepatic vein, which is sectioned by vascular stapler, and the specimen then extracted after biliostatic and hemostatic check. Conclusion: ICG fluorescence imaging with negative staining is useful not only for segmental anatomical resections but safe and efficient technique for both precise parenchymal transection and bile duct resection during anatomical major hemihepatectomy.

Intrahepatic Glissonian Approach to the Ventral Aspect of the Arantius Ligament in Laparoscopic Left Hemihepatectomy.

Laparoscopic left hemihepatectomy using the Glissonian approach is technically challenging secondary to a thick Glissonian pedicle and limited maneuverability of laparoscopic instruments. This procedure demands extreme caution owing to the high risk of bile leakage associated with left hemihepatectomy. We describe the technical details and surgical outcomes of the intrahepatic Glissonian approach to the ventral aspect of the Arantius ligament in laparoscopic left hemihepatectomy. After detachment of the left side of hilar plate, the meticulous dissection was performed in the liver capsule above the left Glissonian pedicle. Dissection of the ventral aspect of the Arantius ligament creates the space between the liver parenchyma and the left Glissonian pedicle. The left Glissonian pedicle was isolated and encircled using the long curved laparoscopic instrument. During the parenchymal transection, the left Glissonian pedicle was transected using lateral to the Arantius ligament. Between February 2013 and July 2018, 13 consecutive patients underwent pure laparoscopic left hemihepatectomy. The median operation time was 230min (range 180-300min), and the median estimated blood loss was 300mL (range 100-600mL). Two patients (15%) required transfusion. The median tumor size was 40mm (range 10-105mm). All patients showed negative resection margins. The median postoperative hospital stay was 8days (range 6-15days). Major postoperative complications occurred in 1 patient (7.7%). No perioperative deaths occurred. An intrahepatic Glissonian approach to the ventral aspect of the Arantius ligament is a feasible and effective technique in laparoscopic left hemihepatectomy.

Pure Laparoscopic Left Hemihepatectomy in patient with HCC

Summary: Minimally invasive surgery has become an irreversible trend. The area of liver resection is not exception. More and more laparoscopic major hepatectomy has been performed at multiple centers as time goes by. The patient was 62-years old man who had been diagnosed HCC in segment 4 due to HBV. We had decided to performed pure laparoscopic left hemihepatectomy because tumor was apart from hilum and major vessels. The operative time was 135 minutes, and estimated blood loss was 50mL. He discharged at POD 5 without any complication. Over 5 months, he had no recurrence of tumor. The authors suggest the laparoscopic major hepatectomy including left hemihepatectomy are safe and feasible procedure in selected patients.

A Modified Liver Hanging Maneuver in Pure Laparoscopic Left Hemihepatectomy with Preservation of the Middle Hepatic Vein: Video and Technique

BackgroundThe liver hanging maneuver is a novel and useful technique that is widely used in open liver resections. The present study describes the surgical technique and outcomes of a modified liver hanging maneuver for pure laparoscopic left hemihepatectomy. MethodThe clinical data of patients who underwent laparoscopic left hemihepatectomy using a modified hanging technique were retrospectively reviewed. The upper end of the hanging tape was placed on the lateral side of the left hepatic vein. The pathway of the tape was situated along the ligamentum venosum. ResultsSixteen patients underwent pure laparoscopic left hemihepatectomy with the modified hanging technique. The median operation time was 225 min (range 180–300 min), with a median blood loss of 265 ml (range 140–600 ml). Postoperative major complications occurred in one patient (6.3%). The median postoperative hospital stay was 8 days (range 5–15 days). There was no postoperative liver failure or mortality. ConclusionThis modified liver hanging maneuver is a simple, safe, and reproducible approach as dissection of between the middle and left hepatic vein is not required. This technique may be useful in laparoscopic left hemihepatectomy.

Pure Laparoscopic Left Hemihepatectomy for Hepatic Peribiliary Cysts with Biliary Intraepithelial Neoplasia.

Introduction. Hepatic peribiliary cysts (HPCs) usually originate due to the cystic dilatation of the intrahepatic extramural peribiliary glands. We describe our rare experience of pure laparoscopic left hemihepatectomy (PLLH) in a patient with HPCs accompanied by a component of biliary intraepithelial neoplasia (BilIN). Case Presentation. A 65-year-old man was referred for further investigation of mild hepatic dysfunction. Contrast-enhanced computed tomography showed dilatation of the left-sided intrahepatic bile duct, and biliary cytology showed class III cells. The patient was highly suspected of having left side-dominated cholangiocarcinoma and underwent PLLH. Microscopic findings revealed multiple cystic dilatations of the extramural peribiliary glands; hence, this lesion was diagnosed as HPCs. The resected intrahepatic bile duct showed that the normal ductal lumen comprised low columnar epithelia; however, front formation on the BilIN was observed in some parts of the intrahepatic bile duct, indicating that the BilIN coexisted with HPCs. Conclusion. We chose surgical therapy for this patient owing to the presence of some features of biliary malignancy. We employed noble PLLH as a minimally invasive procedure for this patient.

Arantius’ ligament approach for the left extrahepatic Glissonean pedicle in pure laparoscopic left hemihepatectomy

Laparoscopic hemihepatectomy has not yet become widely accepted because of the technical difficulties in controlling each Glissonean pedicle laparoscopically. The subjects in the present study included 12 patients who underwent laparoscopic left hemihepatectomy between August 2007 and June 2011. Arantius' ligament was divided. Retracting the caudal stump of the ligament revealed a space between the left Glissonean pedicle and the liver parenchyma. The left Glissonean pedicle could be easily encircled by using an Endo Retract Maxi. No Glissonean injuries, including bleeding or biliary leakage, occurred in any of the 12 patients. Therefore, the Arantius' ligament approach for the left extrahepatic Glissonean pedicle appears to be feasible and safe for successfully performing pure laparoscopic left hemihepatectomy.

Pure Laparoscopic En Bloc Left Hemihepatectomy and Caudate Lobe Resection in Patients with Intrahepatic Cholangiocarcinoma

There is an ongoing debate on whether it is safe to push the boundaries and widen the indications of laparoscopic liver surgery after careful patient selection. We report 2 cases of pure laparoscopic en bloc left hemihepatectomy and caudate lobe resection for intrahepatic cholangiocarcinoma (ICC). The first patient (a 79-year old) had an ICC affecting segments 2, 3, and 4 of the liver with dilatation of segment 1 ducts at preoperative imaging. The second patient (an 81-year old) had an ICC affecting segments 2, 3 with local invasion of segment 1. Both patients underwent pure laparoscopic left hemihepatectomy and caudate lobe resection. The first patient's operative time was 360 minutes and blood loss was 390 mL. Postoperative hospital stay was 8 days. The definitive histology was as follows: pT1 ICC (25 mm in maximal diameter), with 20 mm free resection margin. The second patient's operative time was 310 minutes and blood loss was 300 mL. Postoperative hospital stay was 4 days. The definitive histology was as follows: T1 ICC (49 mm in maximal diameter) with 10 mm free resection margin. The first patient was disease free 12 months after surgery. The second patient died 11 months after surgery of metastatic disease. Pure laparoscopic left hemihepatectomy and caudate lobectomy for ICC may be feasible and safe. This is, however, a very complex procedure requiring extensive experience in laparoscopic liver surgery and careful patient selection to optimize surgical outcome. To our knowledge, this is the first systematic description of a pure laparoscopic en bloc left hemihepatectomy and caudate lobe resection for ICC.

Intrahepatic Glissonian Approach for Pure Laparoscopic Left Hemihepatectomy

Recent advances in laparoscopic devices and experience with advanced techniques have increased the indications for laparoscopic liver. The aim of this work was to present a video with technical aspects of a pure laparoscopic left hemihepatectomy (segments 2, 3, and 4) by using the intrahepatic Glissonian approach and control of venous outflow without hilar dissection or the Pringle maneuver. A 63-year-old woman with a 5-cm solitary liver metastasis was referred for treatment. Four trocars were used. The left lobe was pulled upward and the lesser omentum was divided, exposing Arantius' ligament. This ligament is a useful landmark for the identification of the main left Glissonian pedicle. A small anterior incision was made in front of the hilum, and a large clamp was introduced behind the Arantius' ligament toward the anterior incision, allowing control of the left main sheath. Ischemic discoloration of the left liver was achieved and marked with cautery. The vascular clamp was replaced by a stapler. If ischemic delineation was coincident with a previously marked area, the stapler was fired. The left hepatic vein was dissected and encircled. Parenchymal transection and vascular control of the hepatic veins were accomplished with a Harmonic scalpel and an endoscopic stapling device, as appropriate. All these steps were performed without the Pringle maneuver and without hand assistance. Operative time was 220 minutes with minimum blood loss. Hospital stay was 4 days. Pathology showed free surgical margins. The patient is alive with no signs of recurrence 18 months after the operation. Totally laparoscopic left hemihepatectomy is safe and feasible in selected patients and should be considered for patients with benign or malignant liver neoplasms. The described technique, with the use of the intrahepatic Glissonian approach and control of venous outflow, may facilitate laparoscopic left hemihepatectomy by reducing the technical difficulties in pedicle control and may decrease bleeding during liver transection.