Advertisement

Annals of Surgical Oncology

, Volume 26, Issue 7, pp 2253–2253 | Cite as

Three-Dimensional Ventral Approach with the Modified Liver-Hanging Maneuver During Laparoscopic Right Hemihepatectomy

  • Ji Hoon KimEmail author
Hepatobiliary Tumors

Abstract

Background

The ventral approach differs completely from the caudal approach because of differences in surgical views and the direction of the parenchymal transection.1, 2, 3, 4 A three-dimensional (3D) laparoscopy provides the advantages of better depth perception and spatial orientation.5,6 We present a 3D ventral approach with the modified liver-hanging maneuver during laparoscopic right hemihepatectomy (LRH).

Methods

This was a case of a 78-year-old woman with a 4 cm sized cystic tumor located at the right hemiliver. A 3D flexible laparoscope (Olympus Medical Systems Corp., Tokyo, Japan) was used to provide a bird’s-eye view of the surgical field similar to that in an open approach. In the early phase, parenchymal transection was initiated in the cranioventral area of the liver. The liver parenchyma was transected in a ventral-to-dorsal direction. The segment V hepatic vein was dissected and ligated after identifying the main root of the middle hepatic vein. In the late phase, the dorsal area of the liver around the inferior vena cava and the segment VIII hepatic vein were dissected and ligated using the hanging technique.7,8

Results

The operation time was 240 min, with an estimated blood loss of 70 mL. Total pringle time was 30 min. Final pathologic diagnosis was a 4.0 cm sized mucinous cystic neoplasm with low-grade dysplasia. The patient was discharged on postoperative day 7 without any complications.

Conclusion

The 3D ventral approach with the modified liver-hanging maneuver in LRH is a feasible and useful technique because it resembles open right hemihepatectomy with respect to the surgical concept.

Notes

Disclosures

Dr. Ji Hoon Kim has no conflicts of interest or financial ties to disclose.

Informed Consent

The patient received an explanation of the procedure and provided informed consent.

Ethical Approval

This study was approved by the Institutional Review Board at our institute.

Supplementary material

Supplementary material 1 (WMV 344429 kb)

References

  1. 1.
    Tomishige H, Morise Z, Kawabe N, et al. Caudal approach to pure laparoscopic posterior sectionectomy under the laparoscopy-specific view. World J Gastrointest Surg. 2013;5:173–177.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Ogiso S, Nomi T, Araki K, et al. Laparoscopy-specific surgical concepts for hepatectomy based on the laparoscopic caudal view: a key to reboot surgeons’ minds. Ann Surg Oncol. 2015;22:327–333.CrossRefGoogle Scholar
  3. 3.
    Kim JH. Laparoscopy-specific ventral approach in laparoscopic hemihepatectomy. J Surg Oncol. 2017;116:159–163.CrossRefPubMedGoogle Scholar
  4. 4.
    Kim JH. Ventral approach to the middle hepatic vein during laparoscopic hemihepatectomy. Ann Surg Oncol. 2019;26:290.CrossRefPubMedGoogle Scholar
  5. 5.
    Smith R, Schwab K, Day A, et al. Effect of passive polarizing three-dimensional displays on surgical performance for experienced laparoscopic surgeons. Br J Surg. 2014;101:1453–1459.CrossRefPubMedGoogle Scholar
  6. 6.
    Kawai T, Goumard C, Jeune F, et al. 3D vision and maintenance of stable pneumoperitoneum: a new step in the development of laparoscopic right hepatectomy. Surg Endosc. 2018;32:3706–3712.CrossRefPubMedGoogle Scholar
  7. 7.
    Kim JH, Ryu DH, Jang LC, Choi JW. Lateral approach liver hanging maneuver in laparoscopic anatomical liver resections. Surg Endosc. 2016;30:3611–3617.CrossRefPubMedGoogle Scholar
  8. 8.
    Kim JH. Pure laparoscopic right hepatectomy using modified liver hanging maneuver: technical evolution from caudal approach toward ventral approach. J Gastrointest Surg. 2018;22:1343–1349.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  1. 1.Department of Surgery, College of Medicine, Eulji UniversityEulji University HospitalDaejeonRepublic of Korea

Personalised recommendations