Nomenclature for liver resections was standardized in the brisbane conference. A left l hepatectomy and complete lymph node dissection around the hepatoduodenal ligament and celiac trunk was performed. Extended left hepatectomies are, however, not comparable to any. Pure laparoscopic left hepatectomy using arantius ligament approach combined glissonean pedicle approach with video thanh van le, trieu trieu duong, hieu trung le, quang van vu department of hepatobiliary and pancreatic surgery, central military hospital 108, hanoi, vietnam. This video describes a standard left hepatectomy, utilizing the liver sling approach to define the transection plane. Here we present a video of laparoscopic left hepatectomy for giant hemangioma. There is a potential for major perioperative blood loss, which is a risk factor for postoperative liver failure. Sequential preoperative hepatic vein embolization after. However, the outcomes of pure laparoscopic donor left hepatectomy pldlh are relatively less known than for left lateral sectionectomy or right hepatectomy. The tape should be positioned to surround the left glissons pedicle and lv together as this helps to protect the caudate lobe.
However, the role of hepatic vein embolization is unclear. In current liver surgery, resections up to 70% of functional liver volume have been shown to be safe without the risk of postoperative liver failure. However, its perioperative and oncological outcomes have not been evaluated in left hepatectomy patients. As is emphasised throughout this book it is recommended that the structures to the left side of the liver be isolated within their glissonian sheath and clamped and divided en masse. Download fulltext pdf pure laparoscopic left hemihepatectomy for hepatic peribiliary cysts with biliary intraepithelial neoplasia article pdf available january 2016 with 36 reads. The period of hepatic surgery started with a left lateral hepatic lobectomy performed effectively in germany by langenbuch in the year 1887. In case of a left hepatectomy without mhv, the lhv was dissected from the mhv. Left hepatectomy with caudate lobe resection using the. Recently, the laparoscopic resection on solid organs is performed in standard operation style with the improvement of the laparoscopic instrument and the developing operation technique.
In this study, we evaluated the practice of laparoscopic hepatectomy with the left jackknife position for patients with hcc located in segment vi, vii, or viii. This chapter focuses on major resections, including right hepatectomy, left hepatectomy, and extended right including segment iv and left hepatectomy including the right anterior sector. Pure laparoscopic versus open left hepatectomy including. However, for a left hepatectomy, the line of transection is more towards the left and more in a craniocaudal direction. Identification and isolation of the right hepatic artery and right hepatic duct. Robotic left hepatectomy with revision of hepaticojejunostomy. Long great saphenous vein grafting as temporary coronary.
Robotic left hepatectomy and revision of hepaticojejunostomy were performed smoothly. The era of hepatic surgery began with a left lateral hepatic lobectomy performed successfully by langenbuch in germany in 1887. Anaesthesia for hepatic resection surgery bja education. Left hepatectomy with caudate lobe resection has been widely accepted as the standard treatment for bismuth iiib hilar cholangiocarcinoma 16. Baker 0 1 felicitas koller 0 1 juan carlos caicedo 0 1 0 j. Liver resection for intrahepatic cholangiocarcinoma icc with invasion of the inferior vena cava ivc and hepatic veins hv is a challenging procedure. Laparoscopic left hemihepatectomy llh may be an alternative to open olh.
Left hepatectomy laparoscopic liver, pancreas, and. Short and longterm results of extended left hepatectomy. Between february 20 and september 2017, 21 consecutive patients underwent pure laparoscopic left hepatectomy. An extended left hepatectomy is a complex hepatic resection often performed for large tumours in close relationship to major hilar structures. Between january 1993 and december 2010, 830 patients were diagnosed.
Her biochemistry results were normal except for a ca199 level of 1199 uml. In present study, we describe our initial experiences with robotic hepatectomy, focusing on left. Still, it is not easy to perform liver exploration by using the laparoscope. A hepatectomy operation imposes significant risk on such patients as the fontan circulation can be severely compromised. Hepatectomy is the surgical resection removal of all or part of the liver. Right hepatectomy for multiple colorectal metastases supported with english audio duration. Left hepatectomy is one of the most common types of hepatectomy. In particular abdominal surgeries, surgery is required to rescue the graft flow into the coronary artery. The postoperative outcome was uneventful and the patient was discharged in the 5th postoperative day. Is combined partial hepatectomy with segmental resection. Fully laparoscopic left hepatectomy a technical reference.
Laparoscopic liver resection compared with conventional partial hepatectomya prospective analysis. Pdf since the first laparoscopic anatomical hepatectomy, reported by azagra et al. The liver can regenerate functionally active tissue after resection. Right hepatic lobectomy or extended right hepatic lobectomy. Laparoscopic versus open leftsided hepatectomy for. While the term is often employed for the removal of the liver from a liver transplant donor, this article will focus on partial resections of hepatic tissue and hepatoportoenterostomy. The use of the glissonian sheath approach is also described for removal of segments five and eight in association with a left hepatectomy. Less frequently, this operation is indicated for large, symptomatic benign tumors or for large retroperitoneal tumors involving the.
Radical resection is the only curative treatment for patients with hilar cholangiocarcinoma. We experienced the case of a patient with agenesis of the left hepatic lobe, undergoing laparoscopic hepatectomy for hcc. We begin with the division of falciform ligament and cystic duct and artery. Curr transpl rep minimally invasive living donor hepatectomy talia b. International experience on laparoscopic left hepatectomy. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. In order to perform the procedure, surgeons need to possess all the basic skills for accomplishing any liver resection. Laparoscopic liver resection is currently done for benign lesions of the biliary tract, 1,2 with some biliary diseases requiring bypass surgery as well as liver resection. Minimally invasive techniques in hepatic resection. For the left liver in particular, the laparoscopic camera. We report a case of a 63yearold woman with a 6cm, centrally located liver mass. We report on the preoperative, intraoperative, and postoperative findings of 51.
Additionally, agenesis of the left hepatic lobe accompanied by hepatocellular carcinoma is quite rare. Learn about the open right hepatectomy, an online 3dvideobased course, accredited by the royal college of surgeons of england. Definition a segmental hepatectomy consists of surgical resection of one or more functional anatomic segments of the liver, as originally classified by couinaud fig 1. The position was confirmed with manual palpation of the catheter tip within the ivc, located just below the level of the left renal vein.
The proximal duct is resected at the level of the right portal vein in left hemihepatectomy, whereas it is resected at the level of the right posterior portal vein in left. Here we present a 24yearold woman postfontan operation who successfully underwent a left hepatectomy, and. Since then, hepatectomy has been widely performed for the treatment of various liver diseases, such as malignant tumors, benign tumors, calculi in the intrahepatic ducts, hydatid disease, and abscesses. The mean operative time was 315 min 200445 min and the mean estimated blood loss was 245 ml 125. Minimally invasive living donor hepatectomy pdf paperity. Open versus laparoscopic leftsided hepatectomy trial. Because there are still other problems, such as the styptic matter against bleeding.
The most important points to bear in mind in relation to left hepatectomy are. A right segments vviii or extended right segments ivviii hepatectomy see chapter 18 and fig. At the time of resection his tumor appeared to invade the left and middle hepatic. A systematic literature research was performed to identify comparative studies on llh. Baker laparoscopic approaches to complex hepatobiliary cases are. Fully robotic left hepatectomy for malignant tumor. The role of portal vein embolization to increase future liver remnant flr is wellestablished in the treatment of colorectal liver metastases. Hanging manoeuver for a left hepatectomy using glissons.
Listing a study does not mean it has been evaluated by the u. It is defined as the absence of liver tissue to the left of the gallbladder fossa. Extended left hepatectomy for intrahepatic cholangiocarcinoma. Hepatectomy is done for hepatocellular carcinoma, benign tumor or cyst and for liver transplantation. Agenesis of the left hepatic lobe undergoing laparoscopic. Hepatectomy is the surgical resection of the liver. Robotic liver surgery has been considered as a unique opportunity to overcome the traditional limitations of laparoscopy. A robotic left hepatectomy with revision of hepaticojejunostomy was proposed. This metaanalysis is to compare the clinical outcomes of llh with those of olh. The management of liver metastases from nasopharyngeal carcinoma npc has not been extensively investigated. This minimally invasive left hepatectomy in swine could serve as a useful model in investigations of liver diseases and regeneration, and offers preclinical information. Unlimited viewing of the articlechapter pdf and any associated supplements and figures. Which approach is preferred in left hepatocellular. The response to hepatectomy has been well characterized.
The aim of the present study is to compare the outcomes of left hepatectomy through laparoscopic and open approaches in left hcc. Caicedo northwestern memorial hospital, childrens memorial hospital, northwestern university, feinberg school of medicine, 676 north st claire street suite 1900, chicago, il 60611, usa 1 t. The liver biopsy was consistent with icc and 60% macrosteatosis. Laparoscopic hepatectomy for hepatocellular carcinoma hcc located in segment vi, vii, or viii of the liver is usually difficult because of poor operative exposure, due to the unique anatomical structure. From april 2015 to may 2017, 35 patients underwent fully robotic left hepatectomy. The patient recovered uneventfully and remained symptomsfree at a followup of 20 months.
Rightside versus leftside hepatectomy for the treatment. Pdf pure laparoscopic left hemihepatectomy for hepatic. Extended left hepatectomy, world journal of surgery. Totally laparoscopic living donor left hepatectomy for. While leftside hepatectomy lh may have an oncological disadvantage over rightside hepatectomy rh owing to the contiguous anatomical relationship between right hepatic inflow and biliary confluence, a small future liver remnant after rh could cause worse surgical morbidity and mortality. Open versus laparoscopic leftsided hepatectomy trial olleh the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Extended left hepatectomy resection of couinaud segments ii, iii, iv, v, and viii of the liver has only slowly been appreciated as a viable resectional technique for large, strategically placed, left sided and central hepatic lesions that extend to involve the right anterior sectoral portal pedicular structures. A 77yearold male with a history of cabg using rgea was admitted with a diagnosis of a large hepatocellular carcinoma hcc occupying the whole caudate lobe. Totally laparoscopic living donor left hepatectomy for liver transplantation in a child helayel almodhaiberi 0 1 2 seokhwan kim 0 1 2 kihun kim 0 1 2 0 division of hepatobiliary and liver transplantation, department of general surgery, prince sultan military medical city, riyadh, saudi arabia 1 division of liver transplantation and hepatobiliary surgery, department of surgery, asan. Right and extended right hepatectomy abdominal key. A patient with colorectal liver metastases received neoadjuvant chemotherapy prior to attempted resection. Short and longterm results of extended left hepatectomy for. The commonest indication for hepatic resection in the uk is for liver metastases from colorectal cancer, for which it is the treatment of choice. Laparoscopic left hepatectomy for segment iii intrahepatic.
The robotic approach is beneficial in the fine dissection of the hepatic hilum and revision of hepaticojejunostomy in this particular patient. Additionally, preoperative malnutrition or renal insufficiency, hyperbilirubinemia. Offer starts on jan 8, 2020 and expires on sept 30, 2020. Multicentre evaluation of case volume in minimally. Agenesis of the left hepatic lobe is a rare anomaly. Left hepatectomy in a patient with a fontan circulation. Extended left hepatectomy resection of couinaud segments ii, iii, iv, v, and viii of the liver has only slowly been appreciated as a viable resectional technique for large, strategically placed, leftsided and central hepatic lesions that extend to involve the right anterior sectoral portal pedicular structures. Left hepatectomy for large hepatocellular carcinoma youtube.
Chemotherapyassociated steatohepatitis cash is an increasing challenge in the era of novel chemotherapeutic and biologic agents. Method the patient is placed in modified lithotomy position and the surgeon stands between legs of the patient. Laparoscopic liver resection has been reported as a safe and effective approach for the management of hepatocellular carcinoma hcc. This study aimed to compare the longterm outcome of patients with liver metastases from npc who were treated by a partial hepatectomy or transcatheter hepatic artery chemoembolization tace. Commonly performed segmental resections, including caudate lobe.
Patients with a fontan circulation face the long term risk of cardiac cirrhosis and the subsequent development of hepatocellular carcinoma hcc. From that point forward, hepatectomy has been generally performed for the treatment of different liver illnesses for example, benign tumors and malignant tumors, calculi in the intrahepatic channels, hydatid infection, and abscesses. Purely laparoscopic left hepatectomy with intracorporeal. For example, a liver resection encompassing a posterior sectionectomy and two left sided wedge resections would be categorized as a three segment resection. The first structure that has been dissected out is the left hepatic artery. If the common trunk is long, the dissection is slowly and carefully made with the ultrasonic dissector in the slim parenchyma overlying the common trunk. At the end of your monthly term, you will be automatically renewed at the promotional monthly subscription rate until the end of the promo period, unless you elect to. Although laparoscopic left hepatectomy llh for hepatolithiasis had been successfully performed in a series of cases, its advantages over open left hepatectomy olh are still uncertain. Many commonlyused chemotherapy agents cause damage to hepatocytes, including 5fluorouracil, irinotecan, oxaliplatin, cituximab, and bevacizumab 1114.
The right gastroepiploic artery rgea has been used in coronary artery bypass grafting cabg as an alternative graft. Hypothesis en bloc partial hepatectomy with inferior vena cava ivc resection may be the only curative strategy for patients with hepatic malignancies involving the ivc design retrospective study setting tertiary referral center patients all consecutive patients undergoing combined partial hepatectomy with segmental ivc resection and reconstruction between 1990 and 2002. Ligammentum venosum as an anatomical landmark during pure. Left lobectomy, left trisegmentectomy extended left lobectomy, and left lateral segmentectomy figure 142b. However, there is no clear boundary between the right caudate lobe and the right posterior section. Laparoscopic versus open left lateral hepatic lobectomy. The main left hepatic artery and the branch to segment iv are dissected out individually.