Laparoscopic Assisted Anatomical Liver Resection Utilizing the Hanging Technique

PURPOSE:@The purpose of this work was to evaluate the short term results of the laparoscopic-assisted anatomical liver resections utilizing the hanging technique.
METHODS AND PROCEDURES: From August 2006 to July 2008, there were 13 laparoscopic-assisted anatomical liver resection for treatment of primary and metastatic neoplasm of liver@i4 hepatocellular carcinoma, one cholangiocellular carcinoma, 7 metastasis of colon cancer, one metastasis of ovary carcinomajcarried out at our hospital. The patientsf mean age was 64}10 years. Tumor mean size was 4.0}2.5cm (range: 2 to 10cm). The operation consisted of laparoscopic mobilization of the target liver lobe, followed by open liver resection through a 8-12 cm extraction site. The hanging technique was performed in all cases, which was effective for control of bleeding and guide of direction during anatomic parenchymal transection in a narrow space through the mini-laparotomy. The advantage of this operation is that the same technique and instruments for parenchymal transection than used for open surgery can be used. On the other hand, the laparoscopic technique, which we have to learn, only requires mobilization of the liver to perform the same minimally invasiveness in liver surgery as by totally laparoscopic procedure.
RESULTSFThere were 3 lateral sectionectomy, one anterior sectionectomy, 2 posterior sectionectomy, one left hepatectomy and 6 right hepatectomy. The mean operative time was 376}130minutes. The mean blood loss was 626}627ml and blood transfusion was required in one case of anterior sectionectomy. There were no intraoperative complications and no conversion to laparotomy. Pathological examination showed R0 resections in all cases. Postoperative complications developed in 2 patients (2 bile leaks, 15.3%), all of which was improved by conservative management. However, there was no postoperative mortality. Recurrence was detected in 4 cases of metastases of colon cancer during a mean-follow-up of 11.8 months.
CONCLUSION: laparoscopic-assisted anatomical liver resection is safe and technically feasible. More data may be needed for evaluation of long-term outcome.

Session: Poster

Program Number: P410

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