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Laparoscopic liver resection in the semiprone position for tumors in the anterosuperior and posterior segments, using a novel dual-handling technique and bipolar irrigation system

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Abstract

Background

Hepatic tumors in the lower edge and lateral segments are commonly treated by laparoscopic liver resection. Tumors in the anterosuperior and posterior segments are often large and locally invasive, and resection is associated with a higher risk of insufficient surgical margins, massive intraoperative bleeding, and breaching of the tumor. Laparoscopic surgery for such tumors often involves major hepatectomy, including resection of a large volume of normal liver tissue. We developed a novel method of laparoscopic resection of tumors in these segments with the patient in the semiprone position, using a dual-handling technique with an intercostal transthoracic port. The aim of this study was to evaluate the safety and usefulness of our technique.

Methods

Of 160 patients who underwent laparoscopic liver resection at our center from June 2008 to May 2013, we retrospectively reviewed those with tumors in the anterosuperior and posterior segments. Patients were placed supine or semilateral during surgery until January 2010 and semiprone from February 2010.

Results

Before the introduction of the semiprone position in February 2010, a total of 7 of 40 patients (17.5 %) with tumors in the anterosuperior and posterior segments underwent laparoscopic liver resection, and after introduction of the semiprone position, 69 of 120 patients (57.5 %) with tumors in the anterosuperior and posterior segments underwent laparoscopic liver resection (P < 0.001). There were no conversions to open surgery, reoperations, or deaths. The semiprone group had a significantly higher proportion of patients who underwent partial resection or segmentectomy of S7 or S8, lower intraoperative blood loss, and shorter hospital stay than the supine group (all P < 0.05). Postoperative complication rates were similar between groups.

Conclusions

Laparoscopic liver resection in the semiprone position is safe and increases the number of patients who can be treated by laparoscopic surgery without increasing the frequency of major hepatectomy.

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References

  1. Gagner M, Rheault M, Dubuc J (1992) Laparoscopic partial hepatectomy for liver tumor [abstract]. Surg Endosc 6:99

    Google Scholar 

  2. Hashizume M, Takenaka K, Yanaga K, Ohta M, Kajiyama K, Shirabe K, Itasaka H, Nishizaki T, Sugimachi K (1995) Laparoscopic hepatic resection for hepatocellular carcinoma. Surg Endosc 9(12):1289–1291

    Article  CAS  PubMed  Google Scholar 

  3. Kaneko H, Takagi S, Shiba T (1996) Laparoscopic partial hepatectomy and left lateral segmentectomy: technique and results of a clinical series. Surgery 120(3):468–475

    Article  CAS  PubMed  Google Scholar 

  4. Sato M, Watanabe Y, Ueda S, Kawachi K (1997) Minimally invasive hepatic resection using laparoscopic surgery and minithoracotomy. Arch Surg 132(2):206–208

    Article  CAS  PubMed  Google Scholar 

  5. Shimada M, Harimoto N, Maehara S, Tsujita E, Rikimaru T, Yamashita Y, Tanaka S, Shirabe K (2002) Minimally invasive hepatectomy: modulation of systemic reactions to operation or laparoscopic approach? Surgery 131:S312–S317

    Article  PubMed  Google Scholar 

  6. Teramoto K, Kawamura T, Takamatsu S, Nakamura N, Kudo A, Noguchi N, Irie T, Arii S (2005) Laparoscopic and thoracoscopic approaches for the treatment of hepatocellular carcinoma. Am J Surg 189:474–478

    Article  PubMed  Google Scholar 

  7. Cherqui D, Laurent A, Tayar C, Chang S, Van Nhieu JT, Loriau J, Karoui M, Duvoux C, Dhumeaux D, Fagniez PL (2006) Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives. Ann Surg 243:499–506

    Article  PubMed Central  PubMed  Google Scholar 

  8. Cho A, Yamamoto H, Kainuma O, Souda H, Ikeda A, Takiguchi N, Nagata M (2011) Safe and feasible extrahepatic Glissonean access in laparoscopic anatomical liver resection. Surg Endosc 25:1333–1336

    Article  PubMed  Google Scholar 

  9. Gayet B, Cavaliere D, Vibert E, Perniceni T, Levard H, Denet C, Christidis C, Blain A, Mal F (2007) Totally laparoscopic right hepatectomy. Am J Surg 194:685–689

    Article  PubMed  Google Scholar 

  10. Kazaryan AM, Rosok BI, Marangos IP, Rosseland AR, Edwin B (2011) Comparative evaluation of laparoscopic liver resection for posterosuperior and anterolateral segments. Surg Endosc 25:3881–3889

    Article  PubMed Central  PubMed  Google Scholar 

  11. Yoon YS, Han HS, Cho JY, Ahn KS (2010) Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver. Surg Endosc 24:1630–1637

    Article  PubMed  Google Scholar 

  12. Topal H, Tiek J, Aerts R, Topal B (2012) Outcome of laparoscopic major liver resection for colorectal metastases. Surg Endosc 26:2451–2455

    Article  PubMed  Google Scholar 

  13. Machado MA, Kalil AN (2011) Glissonian approach for laparoscopic mesohepatectomy. Surg Endosc 25(6):2020–2022

    Article  CAS  PubMed  Google Scholar 

  14. Ikeda T, Yonemura Y, Ueda N, Kabashima A, Shirabe K, Taketomi A, Yoshizumi T, Uchiyama H, Harada N, Ijichi H, Kakeji Y, Morita M, Tsujitani S, Maehara Y (2011) Pure laparoscopic right hepatectomy in the semi-prone position using the intrahepatic Glissonian approach and a modified hanging maneuver to minimize intraoperative bleeding. Surg Today 41:1592–1598

    Article  PubMed  Google Scholar 

  15. Ikeda T, Mano Y, Morita K, Hashimoto N, Kayashima H, Masuda A, Ikegami T, Yoshizumi T, Shirabe K, Maehara Y (2013) Pure laparoscopic hepatectomy in semiprone position for right hepatic major resection. J Hepatobiliary Pancreat Sci 20:145–150

    Article  PubMed Central  PubMed  Google Scholar 

  16. Rouviere H (1924) Sur la configuration et la signification du sillon du processus caude. Bull Mem Soc Anat Paris 94:355–358

    Google Scholar 

  17. Hugh TB, Kelly MD, Mekisic A (1997) Rouviere’s sulcus: a useful landmark in laparoscopic cholecystectomy. Br J Surg 84(9):1253–1254

    Article  CAS  PubMed  Google Scholar 

  18. Kawarada Y, Das BC, Taoka H (2000) Anatomy of the hepatic hilar area: the plate system. J Hepatobiliary Pancreat Surg 7(6):580–586

    Article  CAS  PubMed  Google Scholar 

  19. Gumbs AA, Gayet B (2008) Video: the lateral laparoscopic approach to lesions in the posterior segments. J Gastrointest Surg 12(7):1154

    Article  PubMed  Google Scholar 

  20. Ishizawa T, Gumbs AA, Kokudo N, Gayet B (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256:959–964

    Article  PubMed  Google Scholar 

  21. Clavien P, Sarr GM, Fong Y (2007) Atlas of upper gastrointestinal and hepato-pancreato-biliary surgery. Springer, Berlin

    Book  Google Scholar 

  22. Yamamoto Y, Ikai I, Kume M, Sakai Y, Yamauchi A, Shinohara H, Morimoto T, Shimahara Y, Yamamoto M, Yamaoka Y (1999) New simple technique for hepatic parenchymal resection using a Cavitron ultrasonic surgical aspirator and bipolar cautery equipped with a channel for water dripping. World J Surg 23:1032–1037

    Article  CAS  PubMed  Google Scholar 

  23. Itoh S, Fukuzawa K, Shitomi Y, Okamoto M, Kinoshita T, Taketomi A, Shirabe K, Wakasugi K, Maehara Y (2012) Impact of the VIO system in hepatic resection for patients with hepatocellular carcinoma. Surg Today 42:1176–1182

    Article  PubMed  Google Scholar 

  24. Szyrach MN, Paschenda P, Afify M, Schaller D, Tolba RH (2012) Evaluation of the novel bipolar vessel sealing and cutting device BiCision(R) in a porcine model. Minim Invasive Ther Allied Technol 21:402–407

    Article  PubMed  Google Scholar 

  25. Lee KF, Wong J, Cheung YS, Ip P, Wong J, Lai PB (2010) Resection margin in laparoscopic hepatectomy: a comparative study between wedge resection and anatomic left lateral sectionectomy. HPB (Oxford) 12:649–653

    Article  Google Scholar 

  26. Nguyen KT, Laurent A, Dagher I, Geller DA, Steel J, Thomas MT, Marvin M, Ravindra KV, Mejia A, Lainas P, Franco D, Cherqui D, Buell JF, Gamblin TC (2009) Minimally invasive liver resection for metastatic colorectal cancer: a multi-institutional, international report of safety, feasibility, and early outcomes. Ann Surg 250:842–848

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported in part by a grant from the Scientific Research Fund of the Ministry of Education, Culture, Sports, Science and Technology of Japan.

Disclosures

Tetsuo Ikeda, Takao Toshima, Norifumi Harimoto, Youichi Yamashita, Toru Ikegami, Tomoharu Yoshizumi, Yuji Soejima, Ken Shirabe, and Yoshihiko Maehara have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Tetsuo Ikeda, Takao Toshima, Norifumi Harimoto, Youichi Yamashita, Toru Ikegami, Tomoharu Yoshizumi, Yuji Soejima, Ken Shirabe & Yoshihiko Maehara

Authors
  1. Tetsuo Ikeda
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  2. Takao Toshima
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  3. Norifumi Harimoto
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  4. Youichi Yamashita
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  5. Toru Ikegami
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  6. Tomoharu Yoshizumi
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  7. Yuji Soejima
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  8. Ken Shirabe
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  9. Yoshihiko Maehara
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Correspondence to Tetsuo Ikeda.

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Ikeda, T., Toshima, T., Harimoto, N. et al. Laparoscopic liver resection in the semiprone position for tumors in the anterosuperior and posterior segments, using a novel dual-handling technique and bipolar irrigation system. Surg Endosc 28, 2484–2492 (2014). https://doi.org/10.1007/s00464-014-3469-y

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  • DOI: https://doi.org/10.1007/s00464-014-3469-y

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