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Laparoscopi hepatic adenoma resection with segmental clamping

Jose Julio R Monteiro Filho, MD, FACS1, Paulo Jose M de Macedo, MD, FACS1, Paulo Sergio S Reis Junior, MD, FACS2, Joao Gustavo C Duarte, MD3. 1Hospital Miguel Couto, 2Hospital Carlos Chagas, 3Hospital Rios Dor

A 30 years old female was operated 3 months before on deep endometriosis. She was submitted to a laparoscopic rectal resection that developed a leakage that required laparocopic reoperation and ileostomy. A subcapsular posterior hepatic adenoma was found and a laparoscopic resection was planned to be done together with bowel reconstruction.

The procedure started with ileostomy closure and placement of a wound protetor with a trocar(11mm) in the ileostomy site with a pneumo of 12mmHg. Other trocars were placed in the umbilicus(12mm) and in the subcostal area(3 of 5mm and 1 of 12mm). The surgeon standed between the legs, the patient was in a 30 degree left lateral decubitus.

A tourniqet was placed in the liver pedicule in case a Pringle maneuver was needed. The right liver lobe was fully mobilized until the vena cava. The portal pedicule to segments 6 and 7 was dissected and a bulldog clamp was applied. The lesion was resected with a combination of bipolar, advanced bipolar and ultrassonic aspirator without the need of Pringle, with a total blood loss of 50ml. The resection area was argon coagulated and a biologic glue was applied. The gallbladder was removed. No drains were used. The patient was discharged in postoperative day 3.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 78755

Program Number: V199

Presentation Session: Video Loop

Presentation Type: VideoLoop

34

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