Pure Laparoscopic Anatomical Liver Posterior Segmentectomy in Semi-prone Position.

Tetsuo Ikeda, MD PhD, Yoshihiko Maehara, MD PhD. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.



Introduction: Pure laparoscopic liver resection is an effective treatment for hepatic cancer that has spread rapidly. However, its use is limited to tumors that are present in the lower edge and lateral segments of the liver. Because of mobilization of the heavy and fragile liver, reliable handling of vessels and a parenchymal division without massive bleeding are difficult. We developed a method that expands the indications for pure laparoscopic liver resection for hepatic cancer and herein present our technique of laparoscopic anatomical resection for a hepatocellular carcinoma (HCC) that was located in the dorsal liver.


Methods and Procedures: The patient was a 70-year-old man with hepatitis C cirrhosis, Child-Pugh score A. During follow-up computed tomography, a 2.2-cm lesion was observed in the posterior segment with early arterial enhancement and contrast washout; the lesion was subsequently confirmed with an arteriogram. α-Fetoprotein was 13 ng/mL (normal, <20 ng/mL). The ingenuities of our surgical techniques are as follows: (1) The patient is placed in semiprone position when the tumor is present in the right posterior segment. (2) The liver is retracted by neodymium magnet coupling. (3) Hepatic parenchymal division is performed using EnSealTM and water-dripping bipolar forceps. (4) The vessels are individually closed with vascular clips (Hem-o-lokTM). The Pringle maneuver, precoagulation, and parenchymal division with a linear stapler are not performed. The video demonstrates a pure laparoscopic posterior segmentectomy with the patient in semiprone position.

Results: Operative time was 264 min. Blood loss was 220 g, and no perioperative transfusion was required. Postoperative recovery was uneventful, and only simple oral analgesics were required for pain control. The patient was discharged on postoperative day 7. Histology showed a moderately differentiated HCC, and all resection margins were clear.

Conclusions: Pure laparoscopic anatomical hepatectomy for HCC in dorsal liverin the semiprone position using the coupling magnet EnSealTM, water-dripping forceps, and individual closure of vessels was feasible and safe. This procedures is considered to be a safe modality for anatomical laparoscopic hepatectomy. Anatomical laparoscopic resection of many parts of the liver can be possible with our method, and we believe that it will lead to an expansion of the indications for laparoscopic liver resection for HCC.


Session Number: SS19 – Videos: HPB (Hepatobiliary and Pancreas)
Program Number: V028

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