RESUMO
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.