Background and Objectives: Laparoscopic assisted hepatic resection (LAHR) is one of the newly-developed surgical procedures, and requires highly specialized competencies of surgeons for coping with operative bleeding and other complicated difficulties caused by impaired hepatic function. We reviewed our experiences in the LAHR to evaluate whether it was safe and feasible for the treatment of hepatocellular carcinoma (HCC) in patients with severely-impaired hepatic function.
Methods and Procedures: We performed LAHR for HCC in 7 patients from December 2006 to July 2007. The operative procedures were completed by one surgeon experienced in both the conventional hepatic surgery and the advanced laparoscopic surgery. In the procedures of LAHR, the liver parenchyma was transected with newly-developed surgical devices such as microwave coagulators, ultrasonic dissectors, laparoscopic coagulation shears, bipolar electrocoagulations, and endolinear staplers. In the 7 cases, age, sex, preoperative hepatic function, operative procedures, operation time, intraoperative blood loss, postoperative complications, mortality and postoperative hospital stay were retrospectively evaluated.
Results: The seven patients consisted of 6 male and 1 female; mean age, 67 years. All the patients were referred for HCC accompanied with cirrhosis. According to the Child-Pugh score, 2 patients were classified into Class B and 5 patients were classified into Class A. Ascites was identified preoperatively in 5 patients. The mean indocyanine green dye retention at 15 minutes (ICG-R15) value was 32.8% (range, 15.4- 56.3%). The mean tumor size was 2.8 cm (range, 1.5-3.5 cm). Partial resection of the hepatic segment (S2, S3, S6, or S8) was performed in five patients, and lateral segmentectomy was performed in two. Radiofrequency ablation was performed in 2 patients, and partial gastrectomy was performed in 1 patient. The procedures of LAHR were completed and consequently, conversion to laparotomy was not required in all the cases. The mean operation time was 247min (range, 190-345 min). The mean blood loss was 115 ml (range, 5-350 ml), and no blood transfusion was required. The mean postoperative hospital stay was 7.3 days (range, 4–11 days). No postoperative complications or death were identified.
Conclusions: Laparoscopic assisted hepatic resection was evaluated as a safe and feasible option for the treatment of hepatocellular carcinoma in patients with severely-impaired hepatic function when performed by experienced surgeons.
Program Number: P311