The Pure Laparoscopic Hepatectomy Induction in the Low-volume Center

Shinjiro Tomiyasu, MD PhD, Kazutoshi Okabe, MD PhD, Toru Beppu, MD PhD, Osamu Sano, MD PhD, Tsuyoshi Yamanaka, MD PhD, Akira Chikamoto, MD PhD, Kouichi Doi, MD PhD, Masatoshi Ishiko, MD PhD, Keiichiro Kanemitsu, MD PhD, Hideo Baba, MD PhD. NTT West Kyusyu Hospital , Saiseikai Kumamoto Hospital and Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University

 <Introduction> Laparoscopic hepatectomy (LH) was published insurance by partial resection and left lateral segmentectomy in Japan. The progress of surgical tools and the improvement of surgical procedure cased LH spread out in the world. Our hospital: low-volume center in HCC, started pure laparoscopic hepatecomy in this year.
<Aim> To examine pure laparoscopic hepatectomy (Pure-Lap) and laparoscopic assisted hepatectomy (Hybrid) in this hospital.
<Patients and Methods> Patients (n=17) who underwent laparoscopic hepatectomy from 2008. These 17 patients are 15 men and 2 female. The age is 51-85 years old. The disease was 15-hepatocellular carcinoma (HCC) and 2 metastatic liver cancers. As for the preoperative liver function, is liver damage degree A 15, B two and one re-hepatectomy. Indication for LH is 5cm or less in tumor diameter, the surface area of the liver except of left lateral segment, and not invasion to a surrounding tissue. The Hybrid method performed in 12 patients, mobilization under a laparoscope and performed a hepatectomy from a small laparotomy wound. By the Pure-Lap method performed in five patients, we gradually raised intraabdominal pressure in 12cmHg, used CUSA for transection of the liver parenchyma after coagulation by BiClamp. A vessel and the Glisson’s capsule used a clip, ligation or linear staples. The Pure-Lap compared to Hybrid about HCC in bleeding, operative time, an SIRS rate until day 3 after surgery, a CRP level on the postoperative third day and postoperative hospitalization.
<Results>
The bleeding, operative time, an SIRS rate until day 3 after surgery, a CRP level on the postoperative third day, postoperative hospitalization against the Hybrid method by the Pure-Lap method in HCC were not the difference in both groups.
<Conclusions>
In low-volume center in HCC, after the experience of Hybrid method, to introduce the Pure-Lap method is capable and safe.

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