Laparoscopic Left Hepatectomy for Giant Symptomatic Hemangioma

C Palanivelu, MS, MCh, FACS, P Senthilnathan, MS, FACS, R Parthasarathi, MS, P Praveen Raj, MS, S Rajapandian, MS, FRCS. GEM Hospital & Research Centre.

Hemangiomas are the most frequent benign tumors of the liver with an incidence ranging from 5% to 20% and women accounting for the largest part. Life-threatening complications associated with hemangiomas have been reported but their true incidence is poorly documented. Resection of liver hemangioma is indicated in cases of great dimension tumors causing symptoms such as pain, nausea or bloating by compression of adjacent organs.
Laparoscopic liver surgery requires high degree of anatomical knowledge, laparoscopic skills and technical know how of latest state of the art haemostatic and parenchymal split instruments, more so for major hepatic procedures like right hepatectomy and in resection of giant hemangiomas . Here we present a video of laparoscopic left hepatectomy for giant hemangioma.

The patient is placed in modified lithotomy position and the surgeon stands between legs of the patient. We insert 6 ports for the procedure. We begin with the division of falciform ligament and cystic duct and artery. Gall bladder is used to retract the liver cranially which exposes the porta hepatis. The left branch of hepatic artery and portal vein dissected and divided after ligation, preserving branches to caudate lobe. Parenchymal division is started along the Cantlie’s line using different haemostatic and parenchymal splitting instruments which include ultrasonic shears, CUSA, Ligasure, clips and APC. As we reach the posterior surface of liver, left hepatic vein is dissected and divided using endo GIA stapler. The left branch of bile dcut is divided and sutured using 4 0 prolene sutures. Specimen retrieved through pfennesteil incision.

We conclude that laparoscopic left hepatectomy using modified anterior approach with inflow occlusion is safe and feasible in case of giant hemangioma, but should be performed only when expertise and equipments are available.

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