Management of laparoscopic partial hepatectomy for cranial and dorsal lesions in our department

Sena Iwamura, Satoshi Kaihara, Yukiko Kumada, Shoichi Kitano, Kita Ryosuke, Hideyuki Masui, Hiromitsu Kinoshita, Yusuke Sakamoto, Motoko Mizumoto, Masato Kondo, Junji Komori, Hiroki Hashida, Hiroyuki Kobayashi, Kenji Uryuhara, Ryo Hosotani. Kobe City Medical Center General Hospital

BACKGRAUND AND AIM:Although laparoscopic partial hepatectomy (LPH) is becoming popluar, resection of cranial and dorsal lesions has a high degree of difficulty and is associated with massive bleeding, insufficient surgical margins and breaching of tumor. We show you our management that ? using intraoperative echo frequently to ensure the margin of the tumor, ?keeping the operative field dry by pre-coagulation dissection technique (PCD technique) using IO electrode before resection of parenchyma by CUSA to recognize a fine vasculature, and ?considering  introduction of hand-assisted laparoscopic surgery (HALS LPH) and small laparotomy (Hybrid LPH) actively. Among 48 cases of LPH undergone until September 2015 in this policy, there were 13 cases of LPH for S7/8 lesions. We show you the perioperative results and videos of them.

RESULTS:Indications for LPH were two cases of HCC and 11cases of metastasis of colorectal cancer. There were two cases being undergone with other surgery simultaneously (2 cases of resection of colorectal cancer, 2 cases of stoma closure and a case of others). Number of tumors was 9 cases of single tumor, 2 of 2 tumors and 2 of 3 tumors. All cases had Child-Pugh class A liver function (10 cases of 5 points and 3 of 6 points). 12 cases had been naïve for hepatectomy, and a case was re-hepatectomy. The mean operating time spent for liver resection was 290 minutes and the mean amount of bleeding was 55ml. We perform Pure LPH for 7 cases, HALS LPH for 4 cases, and conversion to laparotomy was 2 cases (because of bleeding, adhesion). The early days, HALS LPH and conversion to laparotomy was often seen, but recently it has become possible to undergo pure LPH as possible. We performed Pringle maneuver for 6 cases. Only one case had Grade 2 postoperative complication in Clavien-Dindo classification (use of antibiotics because of sustained high inflammatory reaction). Median postoperative length of stay was 9 days.

CONCLUSIONS:We can undergo LPH for cranial and dorsal lesions safely.