LAPAROSCOPIC HEPATIC LOBECTOMY IN THE PORCINE MODEL

Background: To date, there have been only a few anecdotal reports of l aparoscopic hepatectomy, most of which are limited to wedge resections . The aim of this study was to assess the feasibility of laparoscopic hepatic lobectomy in a porcine model. Methods: Eight pigs were anesthe tized before placement of an abdominal wail lift device and five lapar oscopic ports. With the porta hepatis clamped, the left lateral hepati c lobe was divided with an ultrasonic dissector. Small vessels and duc ts were clipped, larger vascular structures were transected with stapl ers, and surface hemorrhage was controlled with an argon beam coagulat or. Serum liver enzymes (LFTs) and blood counts were drawn pre- and po stoperatively. All animals were killed after 1 week. Results: Mean +/- SEM operating and clamp times were 131 +/- 8 and 39 +/- 2 min, respec tively. There were four intraoperative complications in three animals (three lacerations of the hepatic vein and one lear of the splenic cap sule), all of which were controlled at surgery. Mean blood loss was 18 9 +/- 52 ml, and the mass of the resected specimen was 139 +/- 11 g. T here were no postoperative complications or deaths. White blood cell c ount, hematocrit, and LFTs did not change postoperatively, except for aspartate aminotransferase (AST), which was elevated transiently. Ther e were no bile leaks or intraabdominal abscesses. Conclusions: Laparos copic left hepatic lobectomy was technically feasible in the porcine m odel using an abdominal wall lift device for exposure. Clinical trials are needed to assess its feasibility and limitations before laparosco pic hepatic lobectomy is deemed safe for human use.