Top

Journal of Hepato-Biliary-Pancreatic Sciences

Published in:

01-11-2009 | Topics

Laparoscopic-assisted limited liver resection: technique, indications and results

Authors: Osamu Itano, Naokazu Chiba, Shingo Maeda, Hideo Matsui, Go Oshima, Takeyuki Wada, Takashi Nakayama, Hideki Ishikawa, Yasumasa Koyama, Yuko Kitagawa

Published in: Journal of Hepato-Biliary-Pancreatic Sciences | Issue 6/2009

Abstract

Background/Purpose

The purpose of this work was to evaluate the short-term results of laparoscopic-assisted limited liver resection.

Methods

We analyzed the clinical outcome in 17 patients (mean age 70 ± 8 years) who had undergone laparoscopic-assisted limited liver resection from March 2006 to December 2008. Preoperative diagnoses were HCC in 13 patients and metastasis of colon cancer in 4. The operation consisted of laparoscopic mobilization of the target liver lobe, followed by open liver resection through a 7- to 10-cm extraction site.

Results

Mean tumor size was 3.0 ± 1.1 cm (range 1.2–5 cm). The mean operative time was 362 ± 85 min. The mean blood loss was 451 ± 413 ml, and no blood transfusion was required in any patient. There were no intraoperative complications, and conversion to laparotomy was needed in one case. Postoperative complications developed in 4 cases (4 infections, 24%), all of which were improved by conservative management. However, there was no postoperative mortality. None of the patients had any peritoneal carcinomatosis or port-site or resection site recurrence during a mean follow-up of 18 ± 9.6 months. According to the analysis of the tumor location, the criterion for an adequate tumor location in the right lobe for this operation was set with the tumor at a distance of more than 5 cm from the inferior vena cava and the root of the hepatic vein (5 cm rule).

Conclusion

Laparoscopic-assisted limited liver resection is feasible and well tolerated. Accumulation of more data may be needed for evaluation of long-term outcome.

Nakamura S, Tsuzuki T. Surgical anatomy of the hepatic veins and the inferior vena cava. Surg Gynecol Obstet. 1981;152:43–50.PubMed

Kubota K, Makuuchi M, Kusaka K, Kobayashi T, Miki K, Hasegawa K, et al. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology. 1997;26:1176–81.PubMed

Mullin EJ, Metcalfe MS, Maddern GJ. How much liver resection is too much? Am J Surg. 2005;190:87–97.CrossRefPubMed

Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg. 2003;138:1198–206. discussion 1206.CrossRefPubMed

Melendez JA, Arslan V, Fischer ME, Wuest D, Jarnagin WR, Fong Y, et al. Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. J Am Coll Surg. 1998;187:620–5.CrossRefPubMed

Fan ST, Lo CM, Lai EC, Chu KM, Liu CL, Wong J. Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma. N Engl J Med. 1994;331:1547–52.CrossRefPubMed

Romano F, Franciosi C, Caprotti R, Uggeri F, Uggeri F. Hepatic surgery using the Ligasure vessel sealing system. World J Surg. 2005;29:110–2.CrossRefPubMed

Haghighi KS, Wang F, King J, Daniel S, Morris DL. In-line radiofrequency ablation to minimize blood loss in hepatic parenchymal transection. Am J Surg. 2005;190:43–7.CrossRefPubMed

Kaneko H, Otsuka Y, Tsuchiya M, Tamura A, Katagiri T, Yamazaki K. Application of devices for safe laparoscopic hepatectomy. HPB (Oxford). 2008;10:219–24.

10.

Felekouras E, Prassas E, Kontos M, Papaconstantinou I, Pikoulis E, Giannopoulos A, et al. Liver tissue dissection: ultrasonic or RFA energy? World J Surg. 2006;30:2210–6.CrossRefPubMed

11.

Balaa FK, Gamblin TC, Tsung A, Marsh JW, Geller DA. Right hepatic lobectomy using the staple technique in 101 patients. J Gastrointest Surg. 2008;12:338–43.CrossRefPubMed

12.

Cherqui D, Husson E, Hammoud R, Malassagne B, Stephan F, Bensaid S, et al. Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg. 2000;232:753–62.CrossRefPubMed

13.

Kaneko H, Takagi S, Shiba T. Laparoscopic partial hepatectomy and left lateral segmentectomy: technique and results of a clinical series. Surgery. 1996;120:468–75.CrossRefPubMed

14.

Chen HY, Juan CC, Ker CG. Laparoscopic liver surgery for patients with hepatocellular carcinoma. Ann Surg Oncol. 2008;15:800–6.CrossRefPubMed

15.

Dagher I, Caillard C, Proske JM, Carloni A, Lainas P, Franco D. Laparoscopic right hepatectomy: original technique and results. J Am Coll Surg. 2008;206:756–60.PubMed

16.

Gumbs AA, Gayet B. Totally laparoscopic central hepatectomy. J Gastrointest Surg. 2008;12:1153.CrossRefPubMed

17.

Navarra G, Bartolotta M, Scisca C, Barbera A, Venneri A. Ultrasound-guided radiofrequency-assisted segmental arterioportal vascular occlusion in laparoscopic segmental liver resection. Surg Endosc. 2008;22:1724–8.CrossRefPubMed

18.

Cho JY, Han HS, Yoon YS, Shin SH. Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overcoming current limitations on tumor location. Surgery. 2008;144:32–8.CrossRefPubMed

19.

Elftmann TD, Nelson H, Ota DM, Pemberton JH, Beart RW Jr. Laparoscopic-assisted segmental colectomy: surgical techniques. Mayo Clin Proc. 1994;69:825–33.PubMed

20.

Kwok SP, Lau WY, Carey PD, Kelly SB, Leung KL, Li AK. Prospective evaluation of laparoscopic-assisted large bowel excision for cancer. Ann Surg. 1996;223:170–6.CrossRefPubMed

21.

Mochiki E, Kamimura H, Haga N, Asao T, Kuwano H. The technique of laparoscopically assisted total gastrectomy with jejunal interposition for early gastric cancer. Surg Endosc. 2002;16:540–4.CrossRefPubMed

22.

Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994;4:146–8.PubMed

23.

Mala T, Edwin B. Role and limitations of laparoscopic liver resection of colorectal metastases. Dig Dis. 2005;23:142–50.CrossRefPubMed

24.

Makuuchi M, Takayama T, Kosuge T, Yamazaki S, Yamamoto J, Hasegawa H, et al. The value of ultrasonography for hepatic surgery. Hepatogastroenterology. 1991;38:64–70.PubMed

25.

Parker GA, Lawrence W Jr, Horsley JS 3rd, Neifeld JP, Cook D, Walsh J, et al. Intraoperative ultrasound of the liver affects operative decision making. Ann Surg. 1989;209:569–76. (discussion 576-7).CrossRefPubMed

26.

Koffron AJ, Kung RD, Auffenberg GB, Abecassis MM. Laparoscopic liver surgery for everyone: the hybrid method. Surgery. 2007;142:463–8. (discussion 468 e1-2).CrossRefPubMed

27.

Berends FJ, Kazemier G, Bonjer HJ, Lange JF. Subcutaneous metastases after laparoscopic colectomy. Lancet. 1994;344:58.CrossRefPubMed

28.

Itano O, Watanabe T, Jinno H, Suzuki F, Baba H, Otaka H. Port site metastasis of sigmoid colon cancer after a laparoscopic sigmoidectomy: report of a case. Surg Today. 2003;33:379–82.CrossRefPubMed

29.

Chen YL, Talbot AR, Chang HC, Chen ST, Kuo SJ, Fang HY. Limited hepatic resection by laparoscopy-assisted mini-laparotomy for the treatment of hepatocellular carcinoma in cirrhotic patients. Int Surg. 2008;93:127–32.PubMed

30.

Miyazawa M, Torii T, Toshimitsu Y, Okada K, Ogawa N, Shinozuka N, et al. A new laparoscopic-assisted hepatectomy (LAH) utilizing radiofrequency ablation and high-frequency electrocautery. J Surg Oncol. 2006;93:68–71.CrossRefPubMed

31.

Kaneko H. Laparoscopic hepatectomy: indications and outcomes. J Hepatobiliary Pancreat Surg. 2005;12:438–43.CrossRefPubMed

32.

Yamanaka N, Tanaka T, Tanaka W, Yamanaka J, Yasui C, Ando T, et al. Laparoscopic partial hepatectomy. Hepatogastroenterology. 1998;45:29–33.PubMed

33.

Kamiyama T, Kurauchi N, Nakagawa T, Nakanishi K, Kamachi H, Matsushita M, et al. Laparoscopic hepatectomy with the hook blade of ultrasonic coagulating shears and bipolar cautery with a saline irrigation system. J Hepatobiliary Pancreat Surg. 2005;12:49–54.CrossRefPubMed

34.

Dagher I, Lainas P, Carloni A, Caillard C, Champault A, Smadja C, et al. Laparoscopic liver resection for hepatocellular carcinoma. Surg Endosc. 2008;22:372–8.CrossRefPubMed

35.

Dulucq JL, Wintringer P, Rashid LM. Virtually bloodless laparoscopic liver resection of recurrent hepatoma with a new laparoscopic sealer device: report of our initial laparoscopic experience. Surg Laparosc Endosc Percutan Tech. 2007;17:413–5.CrossRefPubMed

36.

Huang MT, Lee WJ, Wang W, Wei PL, Chen RJ. Hand-assisted laparoscopic hepatectomy for solid tumor in the posterior portion of the right lobe: initial experience. Ann Surg. 2003;238:674–9.CrossRefPubMed

37.

Cuschieri A. Laparoscopic hand-assisted hepatic surgery. Semin Laparosc Surg. 2001;8:104–13.CrossRefPubMed

Title: Laparoscopic-assisted limited liver resection: technique, indications and results
Authors: Osamu Itano
Naokazu Chiba
Shingo Maeda
Hideo Matsui
Go Oshima
Takeyuki Wada
Takashi Nakayama
Hideki Ishikawa
Yasumasa Koyama
Yuko Kitagawa
Publication date: 01-11-2009
Publisher: Springer Japan
Published in: Journal of Hepato-Biliary-Pancreatic Sciences / Issue 6/2009
Print ISSN: 1868-6974
Electronic ISSN: 1868-6982
DOI: https://doi.org/10.1007/s00534-009-0141-3

At a glance: The STEP trials

Springer Medicine

Laparoscopic-assisted limited liver resection: technique, indications and results

Abstract

Background/Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background/Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2009

Laparoscopic major hepato-biliary-pancreatic surgery: formidable challenge to standardization

Role of p38 and JNK in liver ischemia and reperfusion

Intraductal oncocytic papillary neoplasm of the bile duct: the first case of peribiliary gland origin

Laparoscopic hepatectomy for liver tumors: proposals for standardization

In situ surgical procedures for locally advanced pancreatic cancer: partial abdominal evisceration and intestinal autotransplantation

An investigation of the embryologic development of the fascia used as the basis for pancreaticoduodenal mobilization