Totally Laparoscopic Right Hepatectomy with modified liver hanging technique

Gadiyaram Srikanth, MCh, Neel Shetty, DNB. Institute of Gastroenterology, Global Hospitals, Bangalore.

Background:
Challenges of liver manipulation,parenchymal transection and hemostasis were hurdles in the progress of laparoscopic hepatectomy.Major hepatic resections demand a high level of surgical skill.Herein we report a 57 year old male patient who is a follow up case of adenocarcinoma of rectum status post abdominoperineal resection,post chemoradiotherapy who underwent total laparoscopic right hepatectomy for metastasis in the right lobe of liver.

Case Report:
57 year old man known diabetic who underwent abdominoperineal resection for adenocarcinoma rectum(T3N0M0) ,received adjuvant chemoradiotherapy two years back presented with pain in the upper abdomen since two months.On evaluation ,CECT abdomen and PET scan showed metastatic lesions in segment V and VIII of the liver.Serum CEA levels were raised.He underwent 5 port total laparoscopic right hepatectomy .After ligating the right hepatic artery the line of demarcation was defined ,aided by intraoperative ultrasound.Parenchymal transection was achieved by harmonic shears and CUSA.He was started on oral liquids on 2nd post operative day ,abdominal drain was removed on 6th day .The patient was discharged on the 7th postoperative day.

Conclusions:
Laparoscopic right hepatectomy is feasible and safe. Carefull pre operative planning and endosuturing skills are prerequisites in achieving this advanced laparoscopic procedure.

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