Pure laparoscopic hepatectomy in semiprone position for right hepatic major resection

Abstract

BackgroundPure laparoscopic liver resection is technically difficult for tumors located in the dorsal anterior and posterior sectors. We have developed a maneuver to perform pure laparoscopic hepatectomy in the semiprone position which was developed for resecting tumors located in these areas.MethodsThe medical records have been reviewed retrospectively in 30 patients who underwent laparoscopic liver resection in the semiprone position for carcinoma in the dorsal anterior or posterior sectors of the right liver between 2008 and 2011.ResultsSeventeen liver tumors were primary liver tumors and 13 were colorectal metastases. Of the 30 patients, 11 (36.6 %) underwent major hepatectomy [right hemihepatectomy in 7 (23.3 %) and posterior sectionectomy in 4 (13.3 %)]. Anatomical minor resection, such as S6 or S7 segmentectomy, was performed in five patients (16.6 %). Five patients with liver metastasis underwent a simultaneous laparoscopic resection. There was no mortality, reoperation, or conversion to open procedures. There were no hepatectomy-related complications such as postoperative bleeding, bile leakage, or liver failure.ConclusionsPure laparoscopic hepatectomy in the semiprone position for tumors present in the dorsal anterior and posterior sectors is feasible and safe. This method expands the indications for laparoscopic liver resection for tumors.Electronic supplementary materialThe online version of this article (doi:10.1007/s00534-012-0558-y) contains supplementary material, which is available to authorized users.

Long-Term Favorable Surgical Results of Laparoscopic Hepatic Resection for Hepatocellular Carcinoma in Patients with Cirrhosis: A Single-Center Experience over a 10-Year Period

“…Hepatic resections of segments 1, 7, and 8, where Lap-Hx is considered to be difficult to perform, reached up to 17 cases (27%) in our Lap-Hx group using the semiprone position. [6][7][8] Therefore, the selection biases in HCC location indicated for Lap-Hx in our study would be smaller than those of the previous studies. Concerning short-term surgical results, also in our study, less Clavien II or more morbidity (26% vs 10%; p ¼ 0.0459), a lower complication rate of ascites (7% vs 0%; p ¼ 0.0077), and shorter hospital stays (16 vs 10 days; p ¼ 0.0008) of the Lap-Hx group were confirmed.…”

“…From June 2008 in 38 patients (60%), pure Lap-Hx was introduced in our institution, 6 and Lap-Hx for the posterior segment, anterosuperior segment (S8), and caudate lobe was performed with the patient in the semiprone position. 7,8 In patients who underwent the Lap-Hx, bipolar scissors or a Biclamp under the VIO soft-coagulation system (ERBE Elektromedizin) fitted with a silicon tube dropping saline to the tip was used to transect the liver parenchyma. If transection of the liver parenchyma of S7, S8, or the right superior portion of S1 was needed in the Lap-Hx patients, an intracostal port with a balloon was placed under left-lung ventilation.…”

“…5 In June 2008, pure Lap-Hx was introduced in our institution, 6 and Lap-Hx for the posterior segment, anterosuperior segment (S8), and caudate lobe was performed with the patient in the semiprone position. 7,8 Several meta-analyses summarized the surgical results of Lap-Hx for HCC as follows: less blood loss, less frequent need for transfusion, less morbidity, a lower complication rate of ascites, a lower complication rate of liver failure, shorter hospital stays, and no compromise in prognosis. [9][10][11][12][13] However, long-term (ie, more than 10 years) surgical results of Lap-Hx for HCC in patients with cirrhosis have not yet been reported.…”

Evolution and revolution of laparoscopic liver resection in Japan

“…Resection of the right posterosuperior region of the liver should be performed with the patient in the left hemilateral decubitus position, especially for resections requiring mobilization of the right liver from the retroperitoneum 13. The prone position may offer better exposure of right posterior segments and lifts the right hepatic vein anterior to the vena cava, which reduces hepatic venous bleeding 22. The French position, in which the patient is placed in a supine position with the operating surgeon standing between the spread lower limbs, is advocated by some surgeons 23, 24…”

Laparoscopic parenchymal preserving hepatic resections in semiprone position for tumors located in the posterosuperior segments

“…In 2013, they published a case series of 30 laparoscopic resections (27 pure laparoscopic resections) in semiprone position including 11 major resections (7 right hemihepatectomies and 4 posterior sectionectomies) [17]. We started performing laparoscopic liver resections in semiprone position for lesions in the posterosuperior segments in 2012.…”