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Laparoscopic Hepatectomy for Giant Hepatic Hemangioma Using the Involved Intrahepatic Anatomic Markers Approach

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Journal of Gastrointestinal Surgery

Abstract

Background

Hepatic hemangioma has been one of the absolute indications of laparoscopic hepatectomy (LH).1 However, the risk of catastrophic intraoperative bleeding and the difficulty to control it make the laparoscopic treatment of giant hepatic hemangioma (GHH) a technical challenge for hepatobiliary surgeons.2 Herein, we presented a video of LH for GHH using the involved intrahepatic anatomic markers approach.

Methods

A 22-year-old female was referred for treatment of an intractable GHH (18 cm), which involved the left hepatic pedicle, left hepatic vein (LHV), and middle hepatic vein (MHV), resulting in the invisibility of the above intrahepatic anatomic markers on CT. The procedure was performed according to the following steps: (1) dissecting and ligating the left hepatic artery (LHA) and left portal vein (LPV) via intrafascial approach, respectively; (2) cutting the accessory LHA; (3) transecting parenchymal along the demarcation line in a caudal-to-cranial direction and exposing the involved caudal middle hepatic vein (MHV); (4) isolating and transecting the involved left hepatic duct; (5) preserving the integrity of involved MHV; (6) isolating and transecting the left hepatic vein (LHV) and splenic vein (SV); (7) mincing and extracting the specimen. This study was approved by the West China Hospital Ethics Committee and was conducted in accordance with the ethical guidelines of the Declaration of Helsinki. All treatments were performed after obtaining written informed consent from the patients.

Results

The operative time was 286 min, and blood loss during operation was 160 ml. This procedure ensured the integrity of MHV and maximized the residual functional hepatic volume. The histopathologic examination confirmed the hepatic cavernous hemangioma. The patient had an uneventful postoperative recovery and was discharged on the fifth day after operation.

Conclusion

LH using the involved intrahepatic anatomic markers approach is feasible and effective for intractable GHH. Its advantages lie in decreasing the risk of disastrous hemorrhage or open conversion rate while maximizing the postoperative functional hepatic reserve.3

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References

  1. Jinhuan Y, Gang D, Binyao S, et al. Is laparoscopic hepatectomy suitable for giant hepatic hemangioma larger than 10 cm in diameter? Surg Endosc 2020;34:1224-1230.

    Article  PubMed  Google Scholar 

  2. Huang Y, Liao A, Pu X, et al. A randomized controlled trial of effect of 15- or 25-minute intermittent Pringle maneuver on hepatectomy for hepatocellular carcinoma. Surgery 2022;171:1596-1604.

    Article  PubMed  Google Scholar 

  3. Zheng K, Zheng J, Yan L, et al. ASO Author reflections: how to choose the optimal surgical strategy to finish laparoscopic anatomical hepatectomy for a solitary HCC in the left lobe? Ann Surg Oncol 2022;29:2982-2983.

    Article  PubMed  Google Scholar 

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Acknowledgements

Xiangyu Du and Kejie Zheng contributed equally to this study and are co-first authors.

Funding

This study was supported by the Sichuan Province Key Research and Development Project (2019YFS0203), the Key Clinical Research Incubation Project of West China Hospital of Sichuan University (2020HXFH028), and the Key R&D Support Plan of Chengdu Science and Technology Bureau (2021-YF05-00703-SN).

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Author notes

  1. Xiangyu Du and Kejie Zheng contributed equally to this work and are co-first authors.

Authors and Affiliations

  1. Department of Liver Surgery, West China Hospital of Sichuan University, Sichuan Province, Chengdu, 610041, China

    Xiangyu Du, Kejie Zheng & Li Jiang

Authors
  1. Xiangyu Du
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  2. Kejie Zheng
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  3. Li Jiang
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Correspondence to Li Jiang.

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The authors declare no competing interests.

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Du, X., Zheng, K. & Jiang, L. Laparoscopic Hepatectomy for Giant Hepatic Hemangioma Using the Involved Intrahepatic Anatomic Markers Approach. J Gastrointest Surg 27, 1290–1291 (2023). https://doi.org/10.1007/s11605-023-05623-x

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  • DOI: https://doi.org/10.1007/s11605-023-05623-x

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