Technical and Technological innovations of pure laparoscopic hepatectomy, especially for the tumor located anterosuperior and posterior segments.

Tetsuo Ikeda, MD, PhD, M Tomikawa, MD, PhD, T Iguchi, MD, PhD, Y Yamashita, MD, PhD, T Ikegami, MD, PhD, H Uchiyama, MD, PhD, A Oshita, MD, PhD, T Yoshizumi, MD, PhD, Y Soejima, MD, PhD, M Ninomiya, K Shirabe, MD, PhD, Y Maehara. Tel:092-642-5462Fax:092-642-5482Kyushu University.

Background: Laparoscopic liver resection is a common treatment for hepatic tumors in the lower edge and lateral segments. Patients with tumors in the anterosuperior and posterior segments often undergo open surgery and major hepatectomy. We developed a novel method of performing laparoscopic liver resection in the semi-prone position using dual handling technique and bipolar irrigation system.

Methods: Of 160 patients who underwent laparoscopic liver resection at our center from June 1994 to July 2013, we retrospectively studied the patients with tumors in the anterosuperior and posterior segments.

Results: 60 patients were tumor located in anterosuperior and posterior segments were performed pure laparoscopic hepatectomy. There were no conversions to open surgery, reoperations, major complications, or deaths. The semi-prone group had a significantly higher proportion of patients who underwent partial resection or segmentectomy of segment 7 and 8, lower intraoperative blood loss, and shorter hospital stay than the supine group (all P < 0.05). Postoperative complication rates were similar between groups.

Conclusions: Laparoscopic liver resection in the semi-prone position is safe, and increases the number of patients who can be treated by laparoscopic surgery without increasing the frequency of major hepatectomy.