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Totally laparoscopic anatomic S7 segmentectomy using in situ split along the right intersectoral and intersegmental planes

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Abstract

Background

The traditional open or laparoscopic segmentectomy of liver segment 7 (S7) requires exposing and controlling the root of the right hepatic vein(RHV)after full mobilization and lifting up of the right liver before liver transection. This approach violates the “no-touch” principle for malignant tumors, and makes laparoscopic resection technically challenging. So reports on isolated totally laparoscopic anatomic S7 segmentectomy have rarely been reported. This study describes our experience in laparoscopic anatomic S7 segmentectomy using in situ split along the right intersectoral and intersegmental planes of the liver. To our knowledge, this is the first description of this novel approach.

Methods

From September 2017 to May 2019, patients who underwent laparoscopic anatomic S7 segmentectomy for hepatocellular carcinoma at the HPB Surgery Department, Sun Yat-Sen Memorial Hospital entered into this retrospective study. This in situ split approach was designed using main vessels as the plane markers of right intersectoral and intersegmental planes, along which liver transection was carried out. There was no need to mobilize the right liver and control the root of RHV.

Results

There were 9 women and 15 men. The average diameter of the tumors on preoperative CT/MR was 3.4 cm (range 2–6 cm). All the procedures were successfully carried out laparoscopically. There was no perioperative death. The average operative time was 216.5 min (range 180–310 min). The average blood loss was 320 ml (range 120–620 ml). Pathological study showed all the operations to be R0 resections.

Conclusion

Laparoscopic anatomic S7 segmentectomy using the in situ split approach resulted in R0 liver resection in all our patients with primary liver cancer. The operation was technically feasible and it provided a better view and increased maneuverability in the cramped operative space compared with the traditional open/laparoscopic approach. The approach also better complies with the “no-touch” principle for malignant tumors. Its long-term oncological outcomes require further studies.

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References

  1. Lim C, Ishizawa T, Miyata A et al (2016) Surgical indications and procedures for resection of hepatic malignancies confined to segment VII. Ann Surg 263:529–537

    Article  Google Scholar 

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

    Article  Google Scholar 

  3. Xiao L, Li J-W, Zheng S-G (2016) Laparoscopic anatomical segmentectomy of liver segments VII and VIII with the hepatic veins exposed from the head side (with videos). J Surg Oncol 114:752–756

    Article  Google Scholar 

  4. Li W, Zhou X, Huang Z et al (2015) Laparoscopic surgery minimizes the release of circulating tumor cells compared to open surgery for hepatocellular carcinoma. Surg Endosc 29:3146–3153

    Article  Google Scholar 

  5. Guerra F, Bonapasta SA, Annecchiarico M et al (2017) Liver malignancies in segment VII: the role of robot-assisted surgery. Ann Surg 265(6):E80

    Article  Google Scholar 

  6. Ichida H, Ishizawa T, Tanaka M et al (2017) Use of intercostal trocars for laparoscopic resection of subphrenic hepatic tumors. Surg Endosc 31(3):1280–1286

    Article  Google Scholar 

  7. Lee W, Han H-S, Yoon Y-S et al (2014) Role of intercostal trocars on laparoscopic liver resection for tumors in segments 7 and 8. J Hepatobiliary Pancreat Sci 21(8):E65–E68

    Article  Google Scholar 

  8. Li J, Ren H, Du G et al (2018) A systematic surgical procedure: The '7+3' approach to laparoscopic right partial hepatectomy [deep segment (S) VI, S VII or S VIII] in 52 patients with liver tumors. Oncol Lett 15(5):7846–7854

    PubMed  PubMed Central  Google Scholar 

  9. Okuda Y, Honda G, Kurata M et al (2015) A safe and valid procedure for pure laparoscopic partial hepatectomy of the most posterosuperior area: the top of segment 7. J Am Coll Surg 220(3):e17–21

    Article  Google Scholar 

  10. Hasegawa K, Kokudo N, Imamura H et al (2005) Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg 242:252–259

    Article  Google Scholar 

  11. Hidaka M, Eguchi S, Okuda K, et al (2018) Impact of anatomical resection for hepatocellular carcinoma withmicroportal invasion (vp1): a multi-institutional study by the kyushu study group of liver surgery. Ann Surg. https://doi.org/10.1097/SLA.0000000000002981

  12. Figueroa R, Laurenzi A, Laurent A et al (2018) Perihilar glissonian approach for anatomical parenchymal sparing liver resections: technical aspects: the taping game. Ann Surg 267:537–543

    Article  Google Scholar 

  13. Inoue Y, Arita J, Sakamoto T et al (2015) Anatomical liver resections guided by 3-dimensional parenchymal staining using fusion indocyanine green fluorescence imaging. Ann Surg 262:105–111

    Article  Google Scholar 

  14. Cheng KC, Yeung YP, Hui J et al (2011) Multimedia manuscript: laparoscopic resection of hepatocellular carcinoma at segment 7: the posterior approach to anatomic resection. Surg Endosc 25(10):3437

    Article  CAS  Google Scholar 

  15. Buell JF, Cherqui D, Geller DA et al (2009) The international position on laparoscopic liver surgery: the Louisville statement, 2008. Ann Surg 250:825–830

    Article  Google Scholar 

  16. Li W, Zhou X, Huang Z et al (2017) Short-term and long-term outcomes of laparoscopic hepatectomy, microwave ablation, and open hepatectomy for small hepatocellular carcinoma: a 5-year experience in a single center. Hepatol Res 47:650–657

    Article  CAS  Google Scholar 

  17. Cao J, Li G-L, Wei J-X et al (2019) Laparoscopic duodenum-preserving total pancreatic head resection: a novel surgical approach for benign or low-grade malignant tumors. Surg Endosc 33:633–638

    Article  Google Scholar 

  18. Kang W-H, Kim K-H, Jung D-H et al (2018) Long-term results of laparoscopic liver resection for the primary treatment of hepatocellular carcinoma: role of the surgeon in anatomical resection. Surg Endosc 32:4481–4490

    Article  Google Scholar 

  19. Kawaguchi Y, Fuks D, Kokudo N et al (2018) Difficulty of laparoscopic liver resection: proposal for a new classification. Ann Surg 267:13–17

    Article  Google Scholar 

Download references

Funding

This work was supported by Grants from the Natural Science Foundation of China (NOS. 81672419, 81572398) and Special Fund for Clinical Research of Wu Jie Ping Medical Foundation (NO. 320.2710.1816).

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Authors and Affiliations

  1. Department of Hepatobiliopancreatic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Yanjiangxi road 107#, Guangzhou, China

    Jun Cao, Wen-da Li, Rui Zhou, Chang-zhen Shang, Lei Zhang, Hong-wei Zhang & Ya-jin Chen

  2. Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong

    Wan Yee Lau

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  1. Jun Cao
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  2. Wen-da Li
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  3. Rui Zhou
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  5. Lei Zhang
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  6. Hong-wei Zhang
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  7. Wan Yee Lau
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Correspondence to Wan Yee Lau or Ya-jin Chen.

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Disclosures

Drs. Jun Cao, Wen-da Li, Rui Zhou, Chang-zhen Shang, Lei Zhang, Hong-wei Zhang, Wan Yee Lau and Ya-jin Chen have no conflicts of interest or financialties to disclose.

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Cao, J., Li, Wd., Zhou, R. et al. Totally laparoscopic anatomic S7 segmentectomy using in situ split along the right intersectoral and intersegmental planes. Surg Endosc 35, 174–181 (2021). https://doi.org/10.1007/s00464-020-07376-z

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  • DOI: https://doi.org/10.1007/s00464-020-07376-z

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