A novel exposure maneuver in laparoscopic right hepatectomy

Abstract

Background and objectives Laparoscopic access to the posterosuperior and lateral parts of the right liver is difficult for blocked and deep surgical situations. We invented a novel water bag device (WBD) to improve the exposure of the right liver. Methods Eighteen consecutive patients with lesions isolated to the posterosuperior or lateral right liver were included in our research. They underwent laparoscopic right hepatectomy with the help of the device and were compared with previous similar laparoscopic cases of our operating surgeon. Results The device was successfully employed without related complications and provided enhanced and stable surgical exposure. All patients were operated on without the need for blood transfusions or laparotomy conversion. The median operation time and estimated blood loss were 227 minutes (range, 114‐568) and 88 mL (range, 25‐250), respectively. In all cases, tumor‐free surgical margins were confirmed and no major complications were observed. The results were better than those in previous similar laparoscopic cases. Conclusions The WBD is safe and effective for laparoscopic exposure when lesions are located in the posterosuperior and lateral parts of the right liver. With the help of the device, laparoscopic right liver resection is easier to perform instead of undergoing open hepatectomy.

A safe and simple exposure and Pringle maneuver in laparoscopic anatomical liver resection of segment 7

“…Some surgeons employed a hand-assisted technique to facilitate liver exposure, however, the biggest concern of the hand-assisted technique would be that a larger incision, air leakage and fatigue in the inserted hand, and some surgeons consider that this approach is not suitable for lesions in S7 and S8 [ 13 ]. The rotating or elevating device approach is safe and effective for laparoscopic exposure, however, this approach is technically challenging and requires special devices, such as bags, service pipes and pressure infusion systems, and some centers do not have these conditions [ 5 ]. Robotic liver resection is also considered a potential surgical approach for S7 resection because it utilizes articulating instruments, which enables performing S7 resection with fewer surgical procedure limitations.…”

“…However, laparoscopic anatomical liver resection of segment 7 (S7) (LALR-S7) is classified as one of the most difficult procedures to perform because of the tumor location due to poor accessibility, rendering exposure of a proper operative field, handling of instruments difficult and poor control of bleeding during the operation even for an experienced surgeon [ 4 ]. Various solutions for visualization, such as the hanging maneuver, hand-assisted technique, rotating or elevating device and transthoracic approach, and for hemorrhage, such as laparoscopic extracorporeal or intracorporeal Pringle maneuver, have been suggested to overcome the difficult task, but this problem has not been completely resolved thus far [ 5 – 7 ]. During laparoscopic anatomical liver resection of S7 (LALR-S7), a suitable solution for visualization and hemorrhage should be best to integrate, performed not only to minimize bleeding during parenchymal transaction but also to provide a better surgical field and increased maneuverability in the cramped operative space.…”