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Pure laparoscopic right hepatectomy in the semi-prone position using the intrahepatic Glissonian approach and a modified hanging maneuver to minimize intraoperative bleeding

Surgery Today volume 41, Article number: 1592 (2011) Cite this article

Abstract

Purpose

Although laparoscopic liver resection has been widely adopted, performing a pure laparoscopic right hepatectomy remains a challenging procedure. The aim of this report is to evaluate the efficiency of a pure laparoscopic right hepatectomy (PLRH) in the semi-prone position using the intrahepatic Glissonian approach and a modified hanging maneuver.

Methods

Pure laparoscopic right hepatectomy was performed in the semi-prone position with the use of an intrahepatic Glissonian approach and modified hanging maneuver for patients with primary liver cancer (n = 3) and metastatic liver cancer (n = 1).

Results

The intraoperative total blood loss was only 95–140 g (mean: 126.2 g). None of the patients required a blood transfusion, and no serious complications were encountered. The durations of the surgeries ranged from were 308 to 445 min (mean: 394.8 min). The postoperative hospital stay was 8–11 days (mean 9.5 days).

Conclusion

Pure laparoscopic right hepatectomy in the semi-prone position using the intrahepatic Glissonian approach and a modified hanging maneuver is thus considered to be a safe modality, which minimizes intraoperative bleeding.

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References

  1. Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection — 2,804 patients. Ann Surg 2009;250(5):831–841.

    PubMed  Article  Google Scholar 

  2. Kazaryan AM, Pavlik Marangos I, Rosseland AR, Rosok BI, Mala T, Villanger O, et al. Laparoscopic liver resection for malignant and benign lesions: ten-year Norwegian single-center experience. Arch Surg 2010;145(1):34–40.

    PubMed  Article  Google Scholar 

  3. Yoon YS, Han HS, Cho JY, Ahn KS. Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver. Surg Endosc 2010;24(7):1630–1637.

    PubMed  Article  Google Scholar 

  4. Gagner M. Small incision, big surgeon: laparoscopic liver resection for tumors without a doubt: Comment on “Laparoscopic liver resection for malignant and benign lesions: ten-year Norwegian single-center experience”. Arch Surg 20 2010;145(1):40–41

    Article  Google Scholar 

  5. Chang S, Laurent A, Tayar C, Karoui M, Cherqui D. Laparoscopy as a routine approach for left lateral sectionectomy. Br J Surg 2007;94(1):58–63.

    PubMed  Article  CAS  Google Scholar 

  6. Huscher CG, Lirici MM, Chiodini S. Laparoscopic liver resections. Semin Laparosc Surg 1998;5(3):204–210.

    PubMed  CAS  Google Scholar 

  7. Han HS, Yoon YS, Cho JY, Ahn KS. Laparoscopic right hemihepatectomy for hepatocellular carcinoma. Ann Surg Oncol 2010;17(8):2090–2091.

    PubMed  Article  Google Scholar 

  8. Gayet B, Cavaliere D, Vibert E, Perniceni T, Levard H, Denet C, et al. Totally laparoscopic right hepatectomy. Am J Surg 2007;194(5):685–689.

    PubMed  Article  Google Scholar 

  9. Dagher I, O’Rourke N, Geller DA, Cherqui D, Belli G, Gamblin TC, et al. Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg 2009;250(5):856–860.

    PubMed  Article  Google Scholar 

  10. Dagher I, Di Giuro G, Dubrez J, Lainas P, Smadja C, Franco D. Laparoscopic versus open right hepatectomy: a comparative study. Am J Surg 2009;198(2):173–177.

    PubMed  Article  Google Scholar 

  11. Dagher I, Caillard C, Proske JM, Carloni A, Lainas P, Franco D. Laparoscopic right hepatectomy: original technique and results. J Am Coll Surg 2008;206(4):756–760.

    PubMed  Article  Google Scholar 

  12. Cho JY, Han HS, Yoon YS, Shin SH. Outcomes of laparoscopic liver resection for lesions located in the right side of the liver. Arch Surg 2009;144(1):25–29.

    PubMed  Article  Google Scholar 

  13. Jayaraman S, Khakhar A, Yang H, Bainbridge D, Quan D. The association between central venous pressure, pneumoperitoneum, and venous carbon dioxide embolism in laparoscopic hepatectomy. Surg Endosc 2009;23(10):2369–2373.

    PubMed  Article  CAS  Google Scholar 

  14. Sendt W, Schummer W, Altendorf-Hofmann A, Weber T. Paradoxical carbon dioxide embolism during laparoscopic unroofing of a recurrent nonparasitic liver cyst. Can J Surg 2009;52(4):E97–E98.

    PubMed  Google Scholar 

  15. Cho A, Yamamoto H, Nagata M, Takiguchi N, Shimada H, Kainuma O, et al. Safe and feasible inflow occlusion in laparoscopic liver resection. Surg Endosc 2009;23(4):906–908.

    PubMed  Article  Google Scholar 

  16. Topal B, Aerts R, Penninckx F. Laparoscopic intrahepatic Glissonian approach for right hepatectomy is safe, simple, and reproducible. Surg Endosc 2007;21(11):2111.

    PubMed  Article  CAS  Google Scholar 

  17. Belghiti J, Guevara OA, Noun R, Saldinger PF, Kianmanesh R. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg 2001;193(1):109–111.

    PubMed  Article  CAS  Google Scholar 

  18. Akamatsu N, Sugawara Y, Shin N, Ishida T, Shirakawa K, Ozawa F, et al. Modified liver-hanging maneuver designed to minimize blood loss during hepatic parenchymal transection in hemihepatectomy. Surg Today 2010;40(3):239–244.

    PubMed  Article  Google Scholar 

  19. Lee KF, Wong J, Ng W, Cheung YS, Lai P. Feasibility of liver resection without the use of the routine Pringle maneuver: an analysis of 248 consecutive cases. HPB (Oxford) 2009;11(4):332–338.

    Google Scholar 

  20. Kaneko H, Otsuka Y, Tsuchiya M, Tamura A, Katagiri T, Yamazaki K. Application of devices for safe laparoscopic hepatectomy. HPB (Oxford) 2008;10(4):219–224.

    CAS  Google Scholar 

  21. Eiriksson K, Fors D, Rubertsson S, Arvidsson D. Laparoscopic left lobe liver resection in a porcine model: a study of the efficacy and safety of different surgical techniques. Surg Endosc 2009;23(5):1038–1042.

    PubMed  Article  Google Scholar 

  22. Misawa T, Yoshida K, Iida T, Sakamoto T, Gocho T, Hirohara S, et al. Minimizing intraoperative bleeding using a vessel-sealing system and splenic hilum hanging maneuver in laparoscopic splenectomy. J Hepatobiliary Pancreat Surg 2009;16(6):786–791.

    PubMed  Article  Google Scholar 

  23. Yamamoto Y, Ikai I, Kume M, Sakai Y, Yamauchi A, Shinohara H, et al. New simple technique for hepatic parenchymal resection using a Cavitron Ultrasonic Surgical Aspirator and bipolar cautery equipped with a channel for water dripping. World J Surg 1999;23(10):1032–1037.

    PubMed  Article  CAS  Google Scholar 

  24. Koo BN, Kil HK, Choi JS, Kim JY, Chun DH, Hong YW. Hepatic resection by the Cavitron Ultrasonic Surgical Aspirator increases the incidence and severity of venous air embolism. Anesth Analg 2005;101(4):966–970.

    PubMed  Article  Google Scholar 

  25. Abu Hilal M, Underwood T, Taylor MG, Hamdan K, Elberm H, Pearce NW. Bleeding and hemostasis in laparoscopic liver surgery. Surg Endosc; 24(3):572–577.

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Affiliations

  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Tetsuo Ikeda, Ken Shirabe, Akinobu Taketomi, Tomoharu Yoshizumi, Hideaki Uchiyama, Noboru Harada, Hideki Ijichi, Yosihiro Kakeji, Masaru Morita, Shunichi Tsujitani & Yoshihiko Maehara

  2. Department of Surgery, Oita Prefectural Hospital, Oita, Japan

    Yusuke Yonemura & Naoyuki Ueda

  3. Department of Surgery, Kyushu Chuo Hospital, Fukuoka, Japan

    Akira Kabashima

Authors
  1. Tetsuo Ikeda
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  2. Yusuke Yonemura
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  3. Naoyuki Ueda
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  4. Akira Kabashima
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  5. Ken Shirabe
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  6. Akinobu Taketomi
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  7. Tomoharu Yoshizumi
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  9. Noboru Harada
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  11. Yosihiro Kakeji
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  12. Masaru Morita
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  13. Shunichi Tsujitani
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  14. Yoshihiko Maehara
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Ikeda, T., Yonemura, Y., Ueda, N. et al. Pure laparoscopic right hepatectomy in the semi-prone position using the intrahepatic Glissonian approach and a modified hanging maneuver to minimize intraoperative bleeding. Surg Today 41, 1592 (2011). https://doi.org/10.1007/s00595-010-4479-6

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  • DOI: https://doi.org/10.1007/s00595-010-4479-6

Key words

  • Semi-prone position
  • Laparoscopy
  • Liver resection
  • Right hepatectomy
  • Minimal bleeding