Laparoscopic Right Hepatectomy – Selective Hilum Dissection Technique

Kuo-Hsin Chen, MD, Jiann-Ming Wu, MD, Kuo-Hsiang Cheng, Prof

Division of General Surgery, Department of Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan

Objective of the study: Once considered technically challenging, laparoscopic major liver resection has been performed in many expert centers. However, standard approach to laparoscopic right hepatectomy remains to be established. To evaluate the feasibility and results of laparoscopic right hepatectomy performed by selective hilum dissection technique, we retrospectively reviewed the clinical data collected prospectively.

Methods and procedures: From June 2005 to Sep 2012, total 25 patients received laparoscopic right hepatectomy for benign or malignant liver tumors in our institute. Pathologic diagnosis of these patients includes hepatocellular carcinoma in 11, metastatic in 9, benign tumors in 3, cholangiocarcinoma in 1 and 2 donor hepatectomy for living donor liver transplant. The patients with benign tumors include one symptomatic hemangioma, focal nodular hyperplasia and hemangioma in a patient with recent history of colon cancer. Traditional laparoscopic technique was used in 23 patients and robotic assisted approach in 2 patients. Right hepatic artery and portal vein were selectively dissected and ligated before parenchymal dissection except donor hepatectomy. For patients with large tumors, hand assisted liver mobilization technique might be used. No patients needed Pringle maneuver during parenchymal transection.

Results: There were 17 male and 8 female patients who aged from 22 to 80 (mean: 47.5). Postoperative hospital stay ranged from 6 to 25 days (mean: 8.6). Estimated blood low ranged from 50 to 1800 ml (mean: 460). Operation time was between 180 to 590 min (mean: 425). There was no perioperative mortality. There was no bile leakage or bleeding need intervention after surgery. All section margins for malignant tumor were free from tumor involvement. One patient developed pneumonia and stayed in hospital for 25 days.

Conclusion: Laparoscopic or robotic right hepatectomy by selective inflow control technique is feasible with acceptable outcome. Selective hilum dissection provided specific control of hilum structures especially the bile duct and may avoid possible bile duct injury. To decrease blood loss, Pringle maneuver might be consider to reducing inflow from the left pedicle to decrease blood loss in laparoscopic extended right hepatectomy.

Session: Poster Presentation

Program Number: P366