Total Laparoscopic Right Hepatectomy

ABSTRACT

Until now, reports on laparoscopic liver resections have mainly involved the antero-lateral segments (Couinaud segments II~VI), but those on laparoscopic major liver resection including a right hepatectomy are rare. Herein, we report on two total laparoscopic right hepatectomy cases. One patient was a 69-year-old female, with a hepatocellular carcinoma, and the other a 59-year-old female, with right intrahepatic duct stones. A total laparoscopic right hepatectomy was performed using four or five trocars. After cholecystectomy, the right liver was dissected from the IVC and surrounding ligaments until the right hepatic vein was visualized. After full mobilization of the right liver, the right portal vein, hepatic artery and bile duct were dissected and individually divided. The hepatic parenchyma was dissected along the ischemic line, using a Harmonic scalpel, into the superficial parenchyma and CUSA into the deep parenchyma. The large branches of the hepatic veins were controlled with endoclips. The right hepatic vein was transected with endo-GIA. The epigastric trocar site was extensionally incised for removal of the specimen. The operative times were 385 and 480 minutes the first and second case, respectively. Intraoperative transfusion was needed in the second patient due to biliary cirrhosis and distorted anatomy associated with an IHD stone. The two patients were discharged on postoperative days 15 and 6, respectively, without postoperative complications. These cases confirm that a total laparoscopic right hepatectomy is a feasible and safe operation. However, the technical problems, such as long operation time and bleeding during liver parenchymal resection, should be resolved in order that this procedure can be accomplished more safely.