Skip to main content

Advertisement

SpringerLink
Log in

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

  • Topics
  • Evolution and challenge in endoscopic HBP surgery
  • Published:
Journal of Hepato-Biliary-Pancreatic Surgery

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

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

    CAS  PubMed  Google Scholar 

  2. 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.

    CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  CAS  PubMed  Google Scholar 

  6. 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.

    Article  CAS  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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).

    Article  CAS  PubMed  Google Scholar 

  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).

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Endoscopic Surgery Center, Eiju General Hospital, Tokyo, Japan

    Osamu Itano, Naokazu Chiba, Shingo Maeda, Go Oshima, Takeyuki Wada, Takashi Nakayama, Hideki Ishikawa & Yasumasa Koyama

  2. Department of Surgery, Tokai University, Kanagawa, Japan

    Hideo Matsui

  3. Department of Surgery, School of Medicine, Keio University, Tokyo, Japan

    Yuko Kitagawa

  4. Department of Surgery, Eiju General Hospital, 2-23-16 Higashiueno, Taitou-ku, Tokyo, 110-8645, Japan

    Osamu Itano

Authors
  1. Osamu Itano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naokazu Chiba
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shingo Maeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hideo Matsui
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Go Oshima
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takeyuki Wada
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takashi Nakayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hideki Ishikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yasumasa Koyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yuko Kitagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Osamu Itano.

About this article

Cite this article

Itano, O., Chiba, N., Maeda, S. et al. Laparoscopic-assisted limited liver resection: technique, indications and results. J Hepatobiliary Pancreat Surg 16, 711–719 (2009). https://doi.org/10.1007/s00534-009-0141-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00534-009-0141-3

Keywords

Search

Navigation