Clinical feasibility of laparoscopic central bisectionectomy

Sung Hoon Choi, MD. CHA Bundang Medical Center, CHA University

Introduction: Laparoscopic central bisectionectomy (LCB) for centrally located tumor has been rarely attempted. It is come from a technical difficulty due to two different surgical plane and extensive parenchymal transection area resulting long operative time.  

Methods: From April 2014 to August 2015, four of 9 patients underwent central bisectionectomy were performed with a laparoscopic procedure. The initial perioperative outcomes of the laparoscopic group and open group were compared. The laparoscopic procedure was set up as laparoscopic posterior sectionectomy. The patient was placed supine in a reverse Trendelenburg position with right elevation. Four trocars were used and a rubber band self-retraction technique was applied for the two different resectional planes respectively.

Results: There were no conversions to open surgery in the laparoscopic group. The mean operative time in the laparoscopic group was longer to that in the open group (395 ± 57 vs. 288 ± 23 min, respectively, p = 0.007). Intraoperative blood loss was less in the laparoscopic group compared with the open group (1100 ± 336 vs. 960 ± 288 ml, p = 0.522), There was no difference in the surgical margin (0.45 ±0.5 vs.  0.64 ± 0.22 cm, p = 0.470). The length of stay after surgery was shorter in the laparoscopic group ( 8.7 ± 1.2 vs. 12.6 ± 4.4 days, p = 0.141). There was no difference in the rate of postoperative complications between the two groups (1 vs. 1 cases).

Conclusion: LCB is still demanding procedure with long operative time. However, this procedure is feasible and safe in regard to short-term perioperative outcomes. LCB may provide several benefits commonly attributed to minimally invasive surgery in selected patients.

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