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PURE LAPAROSCOPIC LEFT LATERAL SECTIONECTOMY FOR GIANT HEMANGIOMA OF LEFT LATERAL SEGMENT OF LIVER

Srikanth Gadiyaram, Dr, Kumar Parth, Dr, Gaurav Singh, Dr, Yashas H Ramegowda, Dr. Sahasra Hospitals, Centre of Excellence for Gastroenterology, Bangalore, India

Background: Laparoscopic resection has become standard of care for left lateral sectionectomy (LLS), however, there could be technical challenges in laparoscopic resection while dealing with giant tumors. In a medline search we did not come across laparoscopic resection (LLS) for a tumor of this size (25 cm) and believe this to be first such case and  herein present an operative video with steps of laparoscopic LLS.

Case report: 40 year old lady presented with upper abdominal pain and a visible upper abdominal lump. Multidetector triphasic liver CT showed a giant hemangioma, 25 cm wide occupying segment 2 and 3 with feeding vessel being left hepatic artery. Laparoscopic LLS was performed in the following steps.

Step 1 – Camera and working ports were placed three finger breadths below umbilicus to get a reasonable panoramic view and appropriate ergonomics for working since tumor was reaching upto umbilicus. An epigastic 11 mm port was placed to use a 10 mm fan retractor.

Step 2 – The left hepatic artery was dissected looped and clipped

Step 3 – The portal pedical to left lateral segment was dissected and staple transected

Step 4 – Parencymal transection was performed with CUSA in enucleation plane and left hepatic vein was staple transected intraparenchymally

Step 5 – Hemostasis was ensured, small bile leak secured and specimen retrieved through a Pfannensteil incision

The operative time was 210 minutes and blood loss was 50 cc. Postoperative period was uneventful and patient was discharged from hospital on the fourth postoperative day.  She remains asymptomatic four years after her surgery.

Conclusion: Laparoscopic LLS is feasible for giant liver hemangioma. Despite the large size posing a challenge for vision, careful planning to tackle the feeding artery resulted in reduction of size of hemangioma providing more operative room to successfully complete the procedure.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 95326

Program Number: V042

Presentation Session: Exhibit Hall Theater Video Session I

Presentation Type: EHVideo

40

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