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Laparoscopic central hepatectomy using a parenchymal-first approach: how we do it

  • Endoluminal Surgery
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Abstract

Background

Laparoscopic central hepatectomy (LCH) is a difficult and challenging procedure. This study aimed to describe our experience with LCH using a parenchymal-first approach.

Methods

Between July 2017 and June 2021, 19 consecutive patients underwent LCH using a parenchymal-first approach at our institution. Herein, the details of this procedural strategy are described, and the demographic and clinical data of the included patients were retrospectively analyzed.

Results

There were 1 female and 18 male patients, all with hepatocellular carcinoma without major vascular invasion. The mean age was 57 ± 10 years. No patients underwent conversion to open surgery, and no blood transfusions were needed intraoperatively. The average operative duration and the average Pringle maneuver duration were 223 ± 65 min and 58 ± 11 min. respectively. The median blood loss was 200 ml (range: 100–800 ml). Postoperative morbidities occurred in 3 patients (15.8%), including 2 cases of bile leakage and 1 case of acquired pulmonary infection; there were no postoperative complications happened such as bleeding, hepatic failure, or mortality. The average postoperative hospital stay was 10 ± 3 days.

Conclusion

The optimized procedure of LCH using a parenchymal-first approach is not only feasible but also expected to provide an advantage in laparoscopic anatomical hepatectomy.

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Funding

This work was supported by two grants from the National Natural Science Foundation of China (Grant No. 82070642), and the Natural Science Foundation of Guangdong Province (Grant No. 2021A1515012485).

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Authors and Affiliations

  1. Division of Hepatobiliopancreatic Surgery, Department of General Surgery, Nanfang Hospital, Southern Medical University, No.1838, North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China

    Zhipeng Zheng & Jie Zhou

  2. Department of Hepatobiliary Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No.111, Dade Road, Guangzhou, 510120, Guangdong, China

    Zhipeng Zheng, Haorong Xie, Zhangyuanzhu Liu, Xiang Wu, Jianxin Peng, Xuefang Chen & Junming He

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  1. Zhipeng Zheng
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Correspondence to Junming He or Jie Zhou.

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Disclosures

Zhipeng Zheng, Haorong Xie, Zhangyuanzhu Liu, Xiang Wu, Jianxin Peng, Xuefang Chen, Junming He, and Jie Zhou have no conflicts of interest or financial ties to disclose.

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Zheng, Z., Xie, H., Liu, Z. et al. Laparoscopic central hepatectomy using a parenchymal-first approach: how we do it. Surg Endosc 36, 8630–8638 (2022). https://doi.org/10.1007/s00464-022-09163-4

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