Safely Modified Laparoscopic Liver Resection for Segment VI and/or VII Hepatic Lesions Using the Left Lateral Decubitus Position

Abstract

Purpose To explore the feasibility and safety of using the left lateral decubitus position (LLDP) to perform laparoscopic liver resection (LLR) for the treatment of hepatic lesions in segment VI and/or VII. Patients and Methods Clinical data concerning 50 patients underwent LLR including 25 patients in the LLDP and the other 25 patients in the routine operative position (ROP) at Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College (Hangzhou, China) and Shulan (Quzhou) Hospital between March 2019 and May 2022 were retrospectively analyzed. All of the patients underwent LLR while in the LLDP or the ROP for the treatment of hepatic lesions located in segment VI and/or VII. Results The preoperative clinical and laboratory parameters were comparable between the two groups (P > 0.05). All patients completed the surgery successfully. There were two patients required conversion to open resection in the ROP comparing with zero in the LLDP. The mean operative time was 256.9 ± 132.7 minutes in LLDP and 255.7 ± 92.1 minutes in ROP, while the median perioperative blood loss was 100 mL (range: 50–300 mL) in LLDP and 200 mL (range: 50–425 mL), respectively. The postoperative pathological examination showed that margin-negative resection was achieved all of the cases. The important postoperative parameters all returned to normal within five days after the LLR. The mean postoperative hospital stay (15.6 vs 19.3 days; p < 0.05) and the extraction of the drainage tube time (7.8 vs 10.4 days; p < 0.05) were shorter for patients in LLDP. Conclusion The LLDP represents a safe and feasible position for performing LLR in selected patients with lesions in segment VI and/or VII. LLR in the LLDP is helpful in terms of the exposure of the surgical field and the recovery of the patient.

Two Cases of Perihepatitis With the Liver Capsule Irritation Sign: A New Physical Examination Technique

“…The first mechanism that causes observation of the liver capsule irritation sign in perihepatitis is the gravitational drop of the right lobe of the liver when the body is placed in the left lateral recumbent position. Although the liver is anatomically fixed by several ligaments, it is to some extent a mobile organ [9,10], and surgical and radiological studies have reported that the right lobe of the liver drops in the direction of gravity when the patient is in the left lateral recumbent position [11,12]. Clinical studies using ultrasound have also shown that the left lobe of the liver drops in the direction of gravity when the patient is placed in the left lateral recumbent position, indicating that the liver may compress the inferior vena cava in this position [13][14][15].…”