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Laparoscopic Right Hepatectomy: Toward Protocolization and Simplification

Abstract

Background

Major hurdles for laparoscopic right hepatectomy (LapRH) include difficulties in (1) mobilization and (2) applying hanging maneuver and (3) lack of experienced assistants. We discuss the protocolization of lapRH, introducing our simplified technique.

Methods

The procedure was disassembled into six steps: (1) curtailed mobilization of the right liver so as to align the resection plane with the laparoscopic camera view, (2) inflow vascular control, (3) setting up the parenchymal resection applying the rubber band retraction method, (4) parenchymal resection approaching the caudate lobe, (5) a lifting-up maneuver using a laparoscopic grasper or retractor instead of the hanging maneuver, and (6) completion of resection dividing the caudate lobe, right hepatic vein, and remaining ligament.

Results

Between March 2014 and August 2015, 13 LapRH surgeries were attempted. The patients consisted of eight males and five females with a mean age of 58.5 ± 11.6 years. Final pathological diagnoses were hepatocellular carcinoma in seven patients, intrahepatic duct stone in 4, and colorectal liver metastasis in 2. The mean total operative time was 381 ± 66 minutes, and the mean intraoperative estimated blood loss was 633 ± 619 ml. One patient was converted to open surgery. There was no clinically significant complication, and the mean length of stay after surgery was 9.1 ± 2.3 days.

Conclusions

Protocolization and simplification of the procedure may allow professionals to better understand the respective process and determine appropriate port placements, resulting in safe and successful minimally invasive hepatectomy procedures.

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References

  1. Choi SH, Choi GH, Han DH, Choi JS. Laparoscopic liver resection using a rubber band retraction technique: usefulness and perioperative outcome in 100 consecutive cases. Surg Endosc. 2015;29:387–97.

    Article  PubMed  Google Scholar 

  2. Choi GH, Choi SH, Kim SH, Hwang HK, Kang CM, Choi JS, Lee WJ. Robotic liver resection: technique and results of 30 consecutive procedures. Surg Endosc. 2012;26:2247–58.

    Article  PubMed  Google Scholar 

  3. Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection-2, 804 patients. Ann Surg. 2009;250:831–41.

    Article  PubMed  Google Scholar 

  4. Hilal MA, Di Fabio F, Teng MJ, Lykoudis P, Primrose JN, Pearce NW. Single-centre comparative study of laparoscopic versus open right hepatectomy. J Gastrointest Surg. 2011;15:818–23.

    Article  PubMed  Google Scholar 

  5. Palanisamy S, Sabnis SC, Patel ND, et al. Laparoscopic major hepatectomy—technique and outcomes. J Gastrointest Surg. 2015;19:2215–22.

    Article  PubMed  Google Scholar 

  6. Lin NC, Nitta H, Wakabayashi G. Laparoscopic major hepatectomy: a systematic literature review and comparison of 3 techniques. Ann Surg. 2013;257:205–13.

    Article  PubMed  Google Scholar 

  7. Tzanis D, Shivathirthan N, Laurent A, et al. European experience of laparoscopic major hepatectomy. J Hepatobiliary Pancreat Sci. 2013;20:120–4.

    Article  PubMed  Google Scholar 

  8. Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G. Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg. 2016;263:761–77.

    Article  PubMed  Google Scholar 

  9. Brown KM, Geller DA. What is the learning curve for laparoscopic major hepatectomy? J Gastrointest Surg. 2016;20: 1065–71.

    Article  PubMed  Google Scholar 

  10. Geller DA. The hanging maneuver facilitates laparoscopic right hepatectomy. Ann Surg Oncol. 2014;21:3717–8.

    Article  PubMed  Google Scholar 

Download references

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Correspondence to Gi Hong Choi MD PhD.

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Choi, S.H., Choi, G.H., Han, D.H. et al. Laparoscopic Right Hepatectomy: Toward Protocolization and Simplification. Ann Surg Oncol 24, 554–555 (2017). https://doi.org/10.1245/s10434-016-5562-z

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  • DOI: https://doi.org/10.1245/s10434-016-5562-z