Hand-assisted laparoscopic left lateral segmentectomy of the liver for hepatocellular carcinoma with cirrhosis

Abstract

With this method, laparoscopic anatomical hepatectomy can be performed more safely for patients with cirrhosis than by the fully laparoscopic method, although a larger incision is necessary.

Laparoscopic liver resection: results for 70 patients

“…Great care should be taken to avoid injury of the liver or tumor throughout the whole procedure. Some surgeons advocate the hand-assisted technique to facilitate liver exposure and parenchymal transection [1,10], especially in the case of cirrhotic liver [21] or tumor located in the posterior segments of the right liver [19]. In addition, it provides the surgeon the tactile sensation lacking during laparoscopy.…”

A new approach to hand-assisted laparoscopic liver surgery

“…The drawback of both approaches is the surgeon's arm crossing with the camera inserted in the umbilicus, a problem that does not arise with our approach. With our HALS technique, in contrast to these authors [11,12,21,[32][33][34], the patient is in decubitus supine (which may involve less risk in the event of serious vascular lesions) and the surgeon, standing between the patient's legs, inserts the left hand through the hand port and easily mobilises the whole of the right and left lobe. The hand not only allows location of the lesion by palpation but, if necessary, control of the hepatic pedicle, suprahepatic veins and hepatic dissection line to better control haemostasis.…”

Hepatectomia direita por videolaparoscopia

“…A colocação precisa dos trocartes permite uma visão direta do hilo hepático e uma triangulação ergonômica que torna este procedimento demorado mais tolerado pela equipe cirúrgica. Há relatos de que o uso de técnica assistida com a mão facilita a exposição do fígado e a secção do parênquima, especialmente em cirróticos e ainda dá ao cirurgião a sensação táctil perdida na laparoscopia [20][21][22] . Acreditamos que esta técnica dificulta a visão do campo cirúrgico e por este motivo utilizamos técnica totalmente laparoscópica.…”