Laparoscopic right posterior sectionectomy (LRPS): surgical techniques and clinical outcomes
Right posterior sectionectomy is one of the most technically challenging laparoscopic liver resections. Currently, there is limited published data regarding the technique and results required to better understand its safety and feasibility.
To report our experience, results and techniques, highlighting a variety of tips and tricks to facilitate this resection. A video is attached for technical demonstration.
Retrospective review of prospectively maintained databases from June 2006 to June 2016. Three different techniques were used: resection following hilar inflow control, inflow control at Rouviere’s sulcus and resection with intra parenchymal control.
29 LRPS were performed over a 10-year period. Median operative time was 240 min (150–480). Pringle’s manoeuvre was performed in 19 (65.5%) with a median total duration of 35 (20–75) min. Median perioperative blood loss was 600 (100–2500) ml. Additional liver resections were performed in 16 (55.1%). There were two(6.9%) laparoscopic to open conversions. Median postoperative hospital stay was 5 (2–30) days. The median size of the tumour resected was 25 (10–54) mm with median number of resected lesions were 2 (1–4), median free resection margin was 9.5 (1–45) mm, margins were infiltrated (R1) in two (6.7%) cases. There was one death within 30-days (3.4%).
LRPS is feasible, efficient and safe. However, it is a technically challenging procedure and requires advance skills in liver and laparoscopic surgery. Surgeons should be familiar with a variety of approaches as each offers different advantages depending on the location and nature of the lesion, surgical preference and intraoperative findings.
KeywordsLaparoscopic liver resection Right posterior sectionectomy Techniques
Laparoscopic right posterior sectionectomy
Colorectal liver metastasis
Right posterior sectionectomy
Right hepatic artery
Right hepatic vein
Right posterior artery
Right posterior vein
Inferior vena cava
Continuous positive pressure airway
Compliance with ethical standards
Najaf N. Siddiqi, Mahmoud Abuawwad, Mark Halls, Francesco Giovinazzo, Arab Rawashdeh, Anas Aljaiuossi, Dennis Wicherts, Mathieu D’Hondt, and Mohammed Abu Hilal have no conflicts of interest or financial ties to disclose.
Supplementary material 1 (MP4 214597 KB)
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