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Tips and Tricks for a Laparoscopic Approach to Paracaval Liver Segments

Abstract

Background

A dramatic spread of laparoscopic liver surgery has been experienced over the last years. The approach to paracaval liver segments 1 and 9 is still poorly described in literature, mainly due to its technical demands.

Objective

The aim of this article was to introduce a safe and effective approach to paracaval liver segments through laparoscopy.

Methods

A minimally invasive approach to resection of Segments 1 and 9 is presented, and an operative set-up is depicted. A step-by-step technique describing the inferior vena cava (IVC) with left and right hepatic venous junction exposure, segmental pedicle isolation, and parenchymal transection is shown through a video document.

Results

Postoperative courses were uneventful, and patients were discharged on postoperative day 3.

Discussion

The approach to paracaval liver segments requires accurate preoperative case selection, technical, surgical, and anesthesiological expertise in laparoscopic liver surgery, and adequate instrumentary.

Conclusion

Paracaval segments of the liver can be approached safely through laparoscopy by teams with extensive expertise in the field of laparoscopic liver surgery; however, suspected malignant infiltration of the IVC or unclear preoperative anatomy still contraindicate this approach.

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Disclosures

Guido Fiorentini, Francesca Ratti, Federica Cipriani, Marco Catena, Michele Paganelli, and Luca Aldrighetti have no conflicts of interest to disclose, and further disclose any commercial interest they may have in the subject matter of the study and the source of any financial or material support.

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Correspondence to G. Fiorentini MD.

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Fiorentini, G., Ratti, F., Cipriani, F. et al. Tips and Tricks for a Laparoscopic Approach to Paracaval Liver Segments. Ann Surg Oncol 25, 1695–1698 (2018). https://doi.org/10.1245/s10434-018-6432-7

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Keywords

  • Laparoscopic Liver Resection
  • Inferior Vena Cava
  • Parenchymal Transection
  • Left Lateral Section
  • Hemostatic Matrix