Hand-assisted laparoscopic hepatectomy for large liver cancer in 56 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the practical value of hand-assisted laparoscopic hepatectomy for large liver cancer in peripheral segments.</p><p><b>METHODS</b>From March 2004 to December 2007, 56 patients with large liver cancer underwent hand-assisted laparoscopic hepatectomy including 53 cases of hepatocellular carcinoma, 2 cases of cholangiocellular carcinoma, 1 case of hepatic metastatic squamous carcinoma.</p><p><b>RESULTS</b>The operation procedures were completed safely in all patients including 27 left lateral segment hepatectomy, 6 left hemi-hepatectomy and 23 atypical right hepatectomy. Thirty-one cases with hepatic hilum blocking in the procedure and the mean time was 16.7 minutes. Mean surgical time was 105.3 minutes. Mean blood loss was 97 ml. Mean gross tumor size was 8.6 cm. Mean excisional hepatic tissue volume was 10.5 cm. No serious postoperative complications occurred. Mean eating time was 2.1 days. The mean postoperative hospital stay was 7.3 days.</p><p><b>CONCLUSION</b>Hand-assisted laparoscopic hepatectomy for large liver carcinoma is feasible and safe for selected patients.</p>

Hand-assisted laparoscopic hepatectomy for left hepatoma / 中国普通外科杂志

Objective To study the feasibility and safety of hand-assisted laparoscopic hepatectomy for huge left hepatoma.Methods Nine patients with huge left hepatoma underwent hand- assisted laparoscopic hepatectomy including hepatocellular carcinoma(4 cases),intrahepatic cholangioearcinoma(1 case),hepatic metastatic squamous carcinoma(1 case),hepatic cavernous hemangioma(2 cases),and hepatic spindle cell tumor(1 case).The mean age was 45.3 years.AFP was positive in 3 cases and CEA was positive in 1 case.The preoperative liver function was Child-Pugh A in all patients.The procedure included dissection of left hepatic ligaments and portal triad clamping with Pringle's maneuver and hepatectomy.Results The laparoscopic procedures were completed safely in all patients including 6 left lateral segmentectomies and 3 left hemihepatectomies.There was no conversion to laparotomy.Mean surgical time was 111.7 minutes.Mean blood loss was 97.8 ml.Portal triad clamping was used in 8 cases and mean clamping time was 13.4 minutes.Neither formidable bleeding nor gas embolism occurred.There were no serious postoperative complications such as postoperative bleeding or bile leak or liver failure.Liver function recovered within 7 to 10 days.Preoperatively positive AFP and CEA turned negative after operation.The mean postoperative hospital stay was 8.4 days.Four patients with HCC underwent postoperative prophylactic hepatic arterial chemoembolization within the first postoperative month. All patients were tumor-free as evaluated by postoperative follow-up of 4～11 months.Conclusions Hand-assisted laparoscopic hepatectomy for huge left hepatoma is feasible and safe in appropriately selected patients.