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.
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Dagher I, O’Rourke N, Geller DA, Cherqui D, Belli G, Gamblin TC, Lainas P, Laurent A, Nguyen KT, Marvin MR, Thomas M, Ravindra K, Fielding G, Franco D, Buell JF. Laparoscopic Major Hepatectomy: An Evolution in Standard of Care. Ann Surg 2009;250:856–860.
Han HS, Cho JY, Yoon YS. Techniques for performing laparoscopic liver resection in various hepatic locations. J Hepatobiliary Pancreat Surg 2009;16:427–432.
Abu Hilal M, Di Fabio F, Abu Salameh M, Pearce NW. Oncological efficiency analysis of laparoscopic liver resection for primary and metastatic cancer: a single-center UK experience. Arch Surg 2012;147:42–48.
Kaneko H, Takagi S, Otsuka Y, Tsuchiya M, Tamura A, Katagiri T, Maeda T, Shiba T. Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg 2005;189:190–194.
Lin NC, Nitta H, Wakabayashi G. Laparoscopic major hepatectomy: a systematic literature review and comparison of 3 techniques. Ann Surg 2013;257:205–213
Kobayashi A, Miyagawa S, Miwa S, Nakata T. Prognostic impact of anatomical resection on early and late intrahepatic recurrence in patients with hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 2008;15:515–521.
Eguchi S, Kanematsu T, Arii S, Okazaki M, Okita K, Omata M, Ikai I, Kudo M, Kojiro M, Makuuchi M, Monden M, Matsuyama Y, Nakanuma Y, Takayasu K; Liver Cancer Study Group of Japan. Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey. Surgery 2008;143:469–475.
Yamamoto J, Kosuge T, Takayama T, Shimada K, Yamasaki S, Ozaki H, Yamaguchi N, Makuuchi M. Recurrence of hepatocellular carcinoma after surgery. Br J Surg 1996;83:1219–1222.
Regimbeau JM, Kianmanesh R, Farges O, Dondero F, Sauvanet A, Belghiti J. Extent of liver resection influences the outcome in patients with cirrhosis and small hepatocellular carcinoma. Surgery 2002;131:311–317.
Sakon M, Nagano H, Nakamori S, Dono K, Umeshita K, Murakami T, Nakamura H, Monden M. Intrahepatic recurrences of hepatocellular carcinoma after hepatectomy: Analysis based on tumor hemodynamics. Arch Surg 2002;137:94–99.
Honda G, Kurata M, Okuda Y, Kobayashi S, Tadano S, Yamaguchi T, Matsumoto H, Nakano D, Takahashi K. Totally laparoscopic hepatectomy exposing the major vessels. J Hepatobiliary Pancreat Sci 2013;20:435–440.
Okuda Y, Honda G, Kurata M, Kobayashi S, Sakamoto K. Dorsal approach to the middle hepatic vein in laparoscopic left hemihepatectomy. J Am Coll Surg 2014. doi:10.1016/j.jamcollsurg.2014.01.068.
Okuda Y, Honda G, Kurata M, Kobayashi S. A useful and convenient procedure for intermittent vascular occlusion in laparoscopic hepatectomy. Asian J Endosc Surg 2013;6:100–103.
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Honda, G., Kurata, M., Okuda, Y. et al. Totally Laparoscopic Anatomical Hepatectomy Exposing the Major Hepatic Veins from the Root Side: a Case of the Right Anterior Sectorectomy (with Video). J Gastrointest Surg 18, 1379–1380 (2014) doi:10.1007/s11605-014-2538-9
- Laparoscopic hepatectomy
- Anatomical hepatectomy