Dorsal approach with Glissonian approach for laparoscopic right anatomic liver resections

Background Laparoscopic anatomic hepatectomy (LAH) has gradually become a routine surgical procedure. However, how to expose the whole hepatic vein and avoid the hepatic vein laceration is still a challenge because of the caudate lobe, particularly in right hepatectomy. We adopted a dorsal approach combined with Glissionian appraoch to perform laparoscopic right anatomic hepatectomy (LRAH). Methods Twenty patients who underwent LRAH from January 2017 to November 2018 were retrospectively analysed. Of these patients, seven patients underwent laparoscopic right hemihepatectomy (LRH group), seven patients who underwent laparoscopic right posterior hepatectomy (LRPH group), and six patients who underwent laparoscopic hepatectomy for segment 7 (LS7 group). The paracaval portion of caudate lobe could be transected firstly through dorsal approach and the corresponding major hepatic vein could be exposed from its root to the peripheral branches safely. Due to exposure along the major hepatic vein trunk, the remaining liver parenchyma could be quickly transected from dorsal to cranial side. Results The mean age of the patients was 53.8 years and the male: female ratio was 8:12. The median operation time was 306.0 ± 58.2 min and the mean estimated volume of blood loss was 412.5 ± 255.4 mL. The mean duration of postoperative hospital stay was 10.2 days. The mean Pringle maneuver time was 64.8 ± 27.7 min. Five patients received transfusion of 2–4 U of red blood cells. Two patients suffered from transient hepatic dysfunction and one suffered from pleural effusion. None of the patients underwent conversion to an open procedure. The operative duration, volume of the blood loss, Pringle maneuver time, and postoperative hospital stay duration did not differ significantly among the LRH, LRPH, and LS7 groups (P > 0.05). Conclusions Dorsal approach combined with Glissonian approach for right lobe is feasible and effective in laparoscopic right anatomic liver resections.

Dorsal approach with Glissonian approach in laparoscopic anatomic hepatectomy for right lobe

Background: Laparoscopic anatomic hepatectomy (LAH) has gradually become a routine surgical procedure. We previously reported that Glissonian approach combined with major hepatic vein first was effective for LAH. Because dorsal approach could effectively expose the major hepatic vein, we merged it with Glissonian approach in LAH for the right lobe.Methods: Twenty patients who underwent LAH from January 2017 to November 2018 were retrospectively analysed. Of these patients, seven patients underwent laparoscopic right hemihepatectomy (LRH group), seven patients who underwent laparoscopic right posterior hepatectomy (LRPH group), and six patients who underwent laparoscopic hepatectomy for segment 7 (LS7 group). First, the paracaval portion of caudate lobe along the IVC was transected through dorsal approch after the corresponding hepatic pedicles were isolated through Glissonian approach. Next, the liver parenchyma was transected by dorsal approach until the corresponding major hepatic vein was exposed from its trunk to the root. Then, the liver parenchyma was transected by a ventral approach. Finally, the root of the major hepatic vein was transected.Results: The mean age of the patients was 53.8 years and the male: female ratio was 8:12. The median operation time was 306.0 ± 58.2 min and the mean estimated volume of blood loss was 412.5 ± 255.4 mL. The mean duration of postoperative hospital stay was 10.2 days. The mean Pringle maneuver time was 64.8 ± 27.7 min. Five patients received transfusion of 2–4 U of red blood cells. Two patients suffered from transient hepatic dysfunction and one suffered from pleural effusion. None of the patients underwent conversion to an open procedure. The operative duration, volume of the blood loss, Pringle maneuver time, and postoperative hospital stay duration did not differ significantly among the LRH, LRPH, and LS7 groups (P > 0.05).Conclusions: Dorsal approach combined with Glissonian approach for right lobe in LAH is feasible and effective, although it is essential to include more cases for further study.

Dorsal approach with Glissonian approach in laparoscopic anatomic hepatectomy for right lobe

Background Laparoscopic anatomic hepatectomy (LAH) has gradually become a routine surgical procedure. We previously reported that Glissonian approach combined with major hepatic vein first was effective for LAH. Because dorsal approach could effectively expose the major hepatic vein, we merged it with Glissonian approach in LAH for the right lobe. Methods Twenty patients who underwent LAH from January 2017 to November 2018 were retrospectively analysed. Of these patients, seven patients underwent laparoscopic right hemihepatectomy (LRH group), seven patients who underwent laparoscopic right posterior hepatectomy (LRPH group), and six patients who underwent laparoscopic hepatectomy for segment 7 (LS7 group). First, the paracaval portion of caudate lobe along the IVC was transected through dorsal approch after the corresponding hepatic pedicles were isolated through Glissonian approach. Next, the liver parenchyma was transected by dorsal approach until the corresponding major hepatic vein was exposed from its trunk to the root. Then, the liver parenchyma was transected by a ventral approach. Finally, the root of the major hepatic vein was transected. Results The mean age of the patients was 53.8 years and the male: female ratio was 8:12. The median operation time was 306.0 ± 58.2 min and the mean estimated volume of blood loss was 412.5 ± 255.4 mL. The mean duration of postoperative hospital stay was 10.2 days. The mean Pringle maneuver time was 64.8 ± 27.7 min. Five patients received transfusion of 2–4 U of red blood cells. Two patients suffered from transient hepatic dysfunction and one suffered from pleural effusion. None of the patients underwent conversion to an open procedure. The operative duration, volume of the blood loss, Pringle maneuver time, and postoperative hospital stay duration did not differ significantly among the LRH, LRPH, and LS7 groups (P > 0.05). Conclusion Dorsal approach combined with Glissonian approach for right lobe in LAH is feasible and effective, although it is essential to include more cases for further study.

Dorsal approach with Glissonian approach in laparoscopic anatomic hepatectomy for right lobe

Background: Laparoscopic anatomic hepatectomy（LAH）has gradually become the routine surgical procedure. We reported previously that Glissonian approach combined with major hepatic vein first was effective for LAH. Owing to Dorsal approach could expose the major hepatic vein effectively, we merged dorsal approach and Glissonian approach in LAH for right lobe.Methods: Twenty patients who underwent LAH from January 2017 to November 2018 were retrospectively analyzed. These comprised seven patients who underwent laparoscopic right hemihepatectomy (group LRH), seven patients who underwent laparoscopic right posterior hepatectomy (group LRPH), and six patients who underwent laparoscopic hepatectomy for segment 7 (group LS7). Firstly, the corresponding hepatic pedicles were isolated through Glissonian approach. Next, the liver parenchyma was transected by dorsal approach until the corresponding major hepatic vein was exposed. Then liver parenchyma was transected by a ventral approach. Finally, the root of the major hepatic vein was transected.Results: The mean age of the patients was 53.8 years and the male: female ratio was 8:12. The median operation time was 306.0 ± 58.2 min and the mean estimated volume of blood loss was 412.5 ± 255.4 mL. The mean duration of postoperative hospital stay was 10.2 days. The mean Pringle maneuver time was 64.8 ± 27.7 min. Five patients received transfusion of 2–4 U of red blood cells. Two patients suffered from transient hepatic dysfunction and one from pleural effusion. No patient underwent conversion to an open procedure. The operative duration, volume of the blood loss, Pringle maneuver time, and postoperative hospital stay duration did not differ significantly among groups LRH, LRPH, and LS7 (P > 0.05).Conclusion: Dorsal approach combined with Glissonian approach for right lobe in LAH is feasible and effective, though, it is essential to include more cases for further study.

How Far Can We Go with Laparoscopic Liver Resection for Hepatocellular Carcinoma? Laparoscopic Sectionectomy of the Liver Combined with the Resection of the Major Hepatic Vein Main Trunk

Although the reports of laparoscopic major liver resection are increasing, hepatocellular carcinomas (HCCs) close to the liver hilum and/or major hepatic veins are still considered contraindications. There is virtually no report of laparoscopic liver resection (LLR) for HCC which involves the main trunk of major hepatic veins. We present our method for the procedure. We experienced 6 cases: 3 right anterior, 2 left medial, and 1 right posterior extended sectionectomies with major hepatic vein resection; tumor sizes are within 40–75 (median: 60) mm. The operating time, intraoperative blood loss, and postoperative hospital stay are within 341–603 (median: 434) min, 100–750 (300) ml, and 8–44 (18) days. There was no mortality and 1 patient developed postoperative pleural effusion. For these procedures, we propose that the steps listed below are useful, taking advantages of the laparoscopy-specific view. (1) The Glissonian pedicle of the section is encircled and clamped. (2) Liver transection on the ischemic line is performed in the caudal to cranial direction. (3) During transection, the clamped Glissonian pedicle and the peripheral part of hepatic vein are divided. (4) The root of hepatic vein is divided in the good view from caudal and dorsal direction.

Formation of a Tunnel under the Major Hepatic Vein Mouths during Removal of IVC Tumor Thrombus

This study describes a clinical observation of successful implementation of a new surgical maneuver: formation of a cross tunnel under the mouths of the major hepatic veins during removal of a tumor thrombus of the inferior vena cava. This surgical technique helps avoid the usage of “piggyback” mobilization of the liver and the complications associated with it. However, for objective evaluation of this approach, a further clinical study is required.