C Palanivelu, MS, MCh, FACS, P Senthilnathan, MS, FACS, P Praveen Raj, MS, R Parthasarathi, MS, R Sathiyamurthy, MS, Kn Paramesh, MS. GEM Hospital & Research Centre, Coimbatore, INDIA.
Cirrhotic liver background accounts for more than 80% of hepatocellular carcinoma cases. Managing such patients is both complex and challenging. Laparoscpy is now employed more often to treat such patients in a limited centres across the globe.
We present a video of one such patient treated laparoscopically who had hepatoma in segment V with Child A cirrhosis and hepatis B liver
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 right branch of hepatic artery and portal vein dissected and divided after ligation, 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 endo GIA stapler. Specimen retrieved in an endobag through pfennesteil incision.
Conclusion: Laparoscopic right hepatectomy for hepatoma in a cirrhotic background is technically demanding but definitely feasible. Use of various parenchymal division techniques will result in reduced blood loss.