Laparoscopic Central Hepatectomy – A Parenchymal Sparing Alternative

Chen Kuo-hsin, MD, Wu Jiann-Ming, MD, Chen Shian-dian, MD, Chen Ying-Da, MD, Huang Shu-Yi, MD, Jeng Kuo-Shyang, MD, Lin Tzu-Chao, MD, Chang Yin-Jen, MD, Huang His-Yu, MD, Siow Tiing-Foong, MD, Sum Shao-Yin, MD, Loi Chao-Man, MD, Chio U-Chon, MD. Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan.

INTRODUCTION – Laparoscopic hepatectomy has been applied to benign and malignant hepatic tumors in peripheral locations. However, for centrally located tumors especially in cirrhotic liver, the choices of procedure were limited. Central hepatectomy including resection of segment 4 or segment 4,5 and 8 is an alternative to major hepatectomy. However, central hepatectomy involving two resection planes which was closed major hepatic vasculatures. For the complexity, only few laparoscopic central hepatectomy had been reported. Therefore, we reviewed our initial experiences of laparoscopic central hepatectomy.

METHODS – Twenty one consecutive patients with centrally located hepatic tumor received laparoscopic central hepatectomy from June 2008 to May 2013. Demographic data, intraoperative parameters, and postoperative outcomes were assessed.

PROCEDURES – The patient was placed in modified lithotomy position. Intermittent Pringle maneuver was used in most patients in this series. The umbilical fissure of the left liver was dissected first and branches to the S4 were identified and divided. Then parenchymal dissection proceeded along the falciform ligament to the junction between middle hepatic vein (MHV) and inferior vena cava (IVC). The IVC was exposed if possible. Then dissection of right anterior glissonian pedicle followed. Branched to the ventral portion of the right anterior section was dissected and divided. Then parenchymal transection was completed.

RESULTS – The procedure included S4 and ventral part of S5 and S8 in 17 patients, isolate S4 segmentecctomy in 1 and other central hepatectomy in 2. Pathological diagnosis included hepatocellular carcinoma in 16, metastatic from colonorectal cancer in 5 and hemangiocarcoma in 1 patient. The mean tumor size was 4.5 cm (1~7.8). Margin free resection has been achieved in all patients. Mean section margin was 6 mm (1~20). Estimated blood loss was 745 ml (100~1600). There was no open conversion. Five patients (23.8%) needed blood transfusion. Mean postoperative hospital stay was 9.2 days (6~27). Postoperative complications developed in 5 patients (23.8%). Two patients with bile leak received endoscopic papillotomy and stent placement. There was no mortality in this series.

CONCLUSION – Our experience demonstrated that laparoscopic hepatectomy is a safe and feasible procedure for centrally located hepatic tumors in selected patients. The postoperative complication rate was acceptable. However, large randomized control study is necessary to confirm the possible benefits of this approach.

 

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