Laparoscopic right hemihepatectomy for colorectal liver metastases using the glissonean approach

Abstract

Laparoscopic resection of Segment 1 is technically challenging and reports remain limited. In this video we demonstrate our experience and technique for laparoscopic Segment 1 resection in three different settings. Methods: 1) A 56 y-old man diagnosed with solitary Segment 1 liver metastasis from conventional renal cell carcinoma received laparoscopic isolated Segment 1 resection. 2) A 72 y-old man diagnosed with bilobar colorectal liver metastases was submitted to laparoscopic left lateral sectionectomy and simultaneous Segment 1, 7 and 8 wedge resections. 3) A 79 y-old man diagnosed with intrahepatic cholangiocarcinoma underwent a laparoscopic left hemihepatectomy with enbloc Segment 1 resection. Low CVP and careful dissection are essential for a safe and oncologically efficient resection. Results: For all three patients postoperative course was uneventful and R0 resection was confirmed on histological exam. Conclusions: Although challenging, laparoscopic management of lesions in Segment 1 can be completed safely and efficiently for malignant lesions. In this video we demonstrate the surgical techniques we developed and adopted in different clinical settings.