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Laparoscopic Right Hepatectomy: Toward Protocolization and Simplification

 Sung Hoon Choi  ;  Gi Hong Choi  ;  Dai Hoon Han  ;  Sung Won Kwon  ;  Jin Sub Choi 
 Annals of Surgical Oncology, Vol.24(2) : 554-555, 2017 
Journal Title
 Annals of Surgical Oncology 
Issue Date
Blood Loss, Surgical/prevention & control ; Carcinoma, Hepatocellular/pathology ; Carcinoma, Hepatocellular/surgery* ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/surgery* ; Female ; Hepatectomy/methods ; Hepatectomy/standards* ; Humans ; Laparoscopy/methods ; Laparoscopy/standards* ; Liver Neoplasms/secondary ; Liver Neoplasms/surgery* ; Male ; Middle Aged ; Operative Time ; Prognosis
BACKGROUND: Major hurdles for laparoscopic right hepatectomy (LapRH) include difficulties in (1) mobilization and (2) applying hanging maneuver and (3) lack of experienced assistants. We discuss the protocolization of lapRH, introducing our simplified technique. METHODS: The procedure was disassembled into six steps: (1) curtailed mobilization of the right liver so as to align the resection plane with the laparoscopic camera view, (2) inflow vascular control, (3) setting up the parenchymal resection applying the rubber band retraction method, (4) parenchymal resection approaching the caudate lobe, (5) a lifting-up maneuver using a laparoscopic grasper or retractor instead of the hanging maneuver, and (6) completion of resection dividing the caudate lobe, right hepatic vein, and remaining ligament. RESULTS: Between March 2014 and August 2015, 13 LapRH surgeries were attempted. The patients consisted of eight males and five females with a mean age of 58.5 ± 11.6 years. Final pathological diagnoses were hepatocellular carcinoma in seven patients, intrahepatic duct stone in 4, and colorectal liver metastasis in 2. The mean total operative time was 381 ± 66 minutes, and the mean intraoperative estimated blood loss was 633 ± 619 ml. One patient was converted to open surgery. There was no clinically significant complication, and the mean length of stay after surgery was 9.1 ± 2.3 days. CONCLUSIONS: Protocolization and simplification of the procedure may allow professionals to better understand the respective process and determine appropriate port placements, resulting in safe and successful minimally invasive hepatectomy procedures.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
최기홍(Choi, Gi Hong) ORCID logo https://orcid.org/0000-0002-1593-3773
최진섭(Choi, Jin Sub)
한대훈(Han, Dai Hoon) ORCID logo https://orcid.org/0000-0003-2787-7876
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