LAPAROSCOPIC PARTIAL-HEPATECTOMY AND LEFT LATERAL SEGMENTECTOMY - TECHNIQUE AND RESULTS OF A CLINICAL-SERIES

Background. Technical difficulties have impeded the development of lap aroscopic hepatectomy and left lateral segmentectomy by means of lapar oscopy, and the results in a series of 11 consecutive patients are rep orted. Methods. A microwave tissue coagulator is used in combination w ith an ultrasonic surgical aspiratory to divide hepatic parenchyma wit hout pneumoperitoneum. Branched vessels and ducts are clipped and tran sected. The largest vessels were suture ligated in some cases. The end oscopic linear stapler was used to transect the left hepatic vein for left lateral segmentectomy. The resected liver was maneuvered into a s pecimen bag and removed. The argo beam coagulator was used to secure h emostasis of the plane of transection. Results. Eleven patients underw ent laparoscopic hepatic resection. Indications included isolated meta static lesion, hepatocellular carcinoma, hemangioma, Wilson's disease, and hemochromatosis. Three patients underwent left lateral segmentect omy, and eight underwent partial hepatectomy. Ten procedures were perf ormed uneventfully; one patient required conversion to open hepatectom y because of excessive bleeding. Notable differences were seen in bloo d loss compared with open hepatectomy, and no operative complications occurred. Postoperative pain was minimal. Conclusions. The laparoscopi c hepatectomy, especially partial or left lateral segmentectomy, appea rs to be a viable surgical alternative in selected cases.