Abstract
Background
Hepatic resection remains a challenging procedure in laparoscopy, requiring trained surgical teams and specialized centers.1 – 3 Operating on the posterior segments of the liver brings additional concerns, such as vascular control, right liver mobilization from the retroperitoneum and diaphragm, and a large transection area.1 , 3 – 6 Here we present a case of a hepatitis B-positive 42-year-old woman with a neoplastic nodule on the right posterior section of the noncirrhotic liver.
Methods
Pneumoperitoneum was made through a hand port, and three additional trocars were placed. Intrahepatic glissonian pedicle control was achieved after liver mobilization. Parenchymal transection was performed through the demarcation line between the anterior well vascularized and the posterior ischemic right segments of the liver. All surgical steps were performed with hand assistance.
Results
Operative time was 210 min, and estimated blood loss was 300 ml. Postoperative was uneventful. The patient was discharged on the fourth postoperative day. Histological evaluation confirmed the diagnosis of a well-differentiated hepatocellular carcinoma. The patient was free of disease after 18 months of follow-up.
Discussion
Our video shows a standardized operative strategy in which the hand assistance plays important role. Posterosuperior segments of the liver are still less often approached by laparoscopic surgery as a result of its limitations on visualization, mobilization, pedicle control, and parenchymal transection.1 , 3 , 6 Hand assistance helps solve these issues, making assisted resection easier than a purely laparoscopic approach and more advantageous over the open technique, providing the benefits of laparoscopy without compromising oncological safety.7
Article PDF
Similar content being viewed by others
References
Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection—2,804 patients. Ann Surg. 2009;250:831–41.
Buell JF, Thomas MT, Rudich S, et al. Experience with more than 500 minimally invasive hepatic procedures. Ann Surg. 2008;248: 475–86.
Koffron AJ, Auffenberg G, Kung R, et al. Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg. 2007;246:385–92.
Yoon YS, Han HS, Choi YS, et al. Total laparoscopic right posterior sectionectomy for hepatocellular carcinoma. J Laparoendosc Adv Surg Tech A. 2006;16:274–7.
Torzilli G, Donadon M, Marconi M, et al. Systematic extended right posterior sectionectomy: a safe and effective alternative to right hepatectomy. Ann Surg. 2008;247:603–11.
Cho JY, Han HS, Yoon YS, Shin SH. Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overcoming current limitations on tumor location. Surgery. 2008;144:32–8.
Gumbs AA, Gayet B. Video: the lateral laparoscopic approach to lesions in the posterior segments. J Gastrointest Surg. 2008;12: 1154.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary material 1 (MPG 75987 kb)
Rights and permissions
About this article
Cite this article
Herman, P., Krüger, J.A.P., Perini, M.V. et al. Laparoscopic Hepatic Posterior Sectionectomy: A Hand-assisted Approach. Ann Surg Oncol 20, 1266 (2013). https://doi.org/10.1245/s10434-012-2750-3
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-012-2750-3