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.
This is a preview of subscription content, access via your institution.
References
Couinaud C. The paracaval segments of the liver. J Hepato Biliary Pancreat Surg. 1994;1:145–51. https://doi.org/10.1007/BF01222238.
Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, et al. A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci. 2014;21(10):745–53. https://doi.org/10.1002/jhbp.166.
Li H, Wei Y, Li B, Peng B. Laparoscopic hepatectomy for segments I, IV, V and VIII. Surg Endosc. 2017;31(7):3028–9. https://doi.org/10.1007/s00464-016-5319-6.
Kawaguchi Y, Velayutham V, Fuks D, Mal F, Kokudo N, Gayet B. Operative techniques to avoid near misses during laparoscopic hepatectomy. Surgery. 2017;161(2):341–6. https://doi.org/10.1016/j.surg.2016.07.023.
Ratti F, Cipriani F, Reineke R, Catena M, Comotti L, Beretta L, et al. Impact of ERAS approach and minimally-invasive techniques on outcome of patients undergoing liver surgery for hepatocellular carcinoma. Dig Liver Dis. 2016;48(10):1243–8. https://doi.org/10.1016/j.dld.2016.06.032.
Yang R, Tao W, Chen YY, Zhang BH, Tang JM, Zhong S, et al. Enhanced recovery after surgery programs versus traditional perioperative care in laparoscopic hepatectomy: a meta-analysis. Int J Surg. 2016;36(Pt A):274–82. https://doi.org/10.1016/j.ijsu.2016.11.017.
Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection—2804 patients. Ann Surg. 2009;250(5):831–41. https://doi.org/10.1097/SLA.0b013e3181b0c4df.
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.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary material 1 (MP4 262102 kb)
Rights and permissions
About this article
Cite this article
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
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-018-6432-7