Abstract
Background
Pure laparoscopic hemihepatectomy is still a challenging procedure. However, it is a minimally invasive liver surgery that leads to rapid recovery [1–5]. Intrahepatic cholangiocarcinoma has a poor prognosis, especially when it occurs with lymph node metastasis [6–8]. We recently had a patient who underwent a pure laparoscopic right hepatectomy and lymph nodes dissection for a large intrahepatic cholangiocarcinoma in the right liver by an anterior approach with hanging maneuver.
Methods
Because the tumor was 77 × 50 mm in diameter, mobilization was performed after the devascularization of the right liver. After the division of the right hepatic artery and the right portal vein, short hepatic veins were sealed and divided with a bipolar vessel sealer from the anterior face of the vena cava, followed by the placement of a tape between the liver and the vena cava for hanging. By means of the hanging maneuver, parenchymal transection was performed with minimal blood loss, and the cut surface of the liver became plane.
Results
The operation time was 357 min, and the blood loss was 66 ml. A right hepatectomy and complete lymph node dissection adjacent to the hepatoduodenal ligament were performed successfully with a purely laparoscopic procedure. The postoperative hospital stay was 10 days. The final diagnosis of the intrahepatic cholangiocarcinoma with distant lymph node metastasis in the hepatoduodenal ligament was pT1N1M0 stage IIIb (International Union Against Cancer criteria).
Conclusions
The laparoscopic procedure enabled the patient to have an early discharge and adjuvant chemotherapy of gemcitabine with S1 initiated immediately after discharge. We present a video of the described procedure.
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References
Cherqui D, Husson E, Hammoud R, Malassagne B, Stéphan F, Bensaid S, Rotman N, Fagniez PL (2000) Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg 232:753–762
Gigot JF, Glineur D, Azagra JS, Goergen M, Ceuterick M, Morino M, Etienne J, Marescaux J, Mutter D, van Krunckelsven L, Descottes B, Valleix D, Lachachi F, Bertrand C, Mansvelt B, Hubens G, Saey JP, Schockmel R, Hepatobiliary and Pancreatic Section of the Royal Belgian Society of Surgery and the Belgian Group for Endoscopic Surgery (2002) Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study. Ann Surg 236:90–97
Koffron AJ, Auffenberg G, Kung R, Abecassis M (2007) Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg 246:385–392
Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection—2,804 patients. Ann Surg 250: 831–841
Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS, World Consensus Conference on Laparoscopic Surgery (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830
Inoue K, Makuuchi M, Takayama T, Torzilli G, Yamamoto J, Shimada K, Kosuge T, Yamasaki S, Konishi M, Kinoshita T, Miyagawa S, Kawasaki S (2000) Long-term survival and prognostic factors in the surgical treatment of mass-forming type cholangiocarcinoma. Surgery 127:498–505
Uenishi T, Hirohashi K, Kubo S, Yamamoto T, Yamazaki O, Kinoshita H (2001) Clinicopathological factors predicting outcome after resection of mass-forming intrahepatic cholangiocarcinoma. Br J Surg 88:969–974
Shimada M, Yamashita Y, Aishima S, Shirabe K, Takenaka K, Sugimachi K (2001) Value of lymph node dissection during resection of intrahepatic cholangiocarcinoma. Br J Surg 88: 1463–1466
Disclosures
Masahiro Takahashi, Go Wakabayashi, Hiroyuki Nitta, Daiki Takeda, Yasushi Hasegawa, Takeshi Takahara, and Naoko Ito have no conflicts of interest or financial ties to disclose.
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Takahashi, M., Wakabayashi, G., Nitta, H. et al. Pure laparoscopic right hepatectomy by anterior approach with hanging maneuver for large intrahepatic cholangiocarcinoma. Surg Endosc 27, 4732–4733 (2013). https://doi.org/10.1007/s00464-013-3202-2
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DOI: https://doi.org/10.1007/s00464-013-3202-2