Laparoscopic Left Hepatectomy Without Inflow Occlusion Using Modified Anterior Approach

INTRODUCTION: 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 .We describe the technique of laparoscopic left hepatectomy by anterior approach performed by single surgeon using two hand technique.
METHOD: The patient is placed in modified lithotomy position and the surgeon stands between legs of the patient. We insert 6 ports and a hand port for parenchymal split or specimen retrieval. 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, bile duct and portal vein dissected and divided, preserving branches to caudate lobe. Retrohepatic veins are then divided, followed by parenchymal division 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 endoGIA stapler. Finally, attachments of the left lobe are divided and specimen retrieved. The intra and post operative variables by this approach compares favorably with open approach.
CONCLUSION: We conclude that laparoscopic left hepatectomy using modified anterior approach without inflow occlusionis safe and feasible, but should be performed only when expertise and equipments are available.

Session: Podium Video Presentation

Program Number: V014

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