Early Hand-Assisted Laparoscopic Resection of Ruptured Hepatocellular Carcinoma

Abstract

Laparoscopic liver resection has increasingly been used as a therapeutic modality in hepatocellular carcinoma (HCC). However, its use in the treatment of spontaneously ruptured HCC has not been well documented. We describe a case of spontaneously ruptured HCC successfully treated with hand-assisted laparoscopic liver resection.

Factors associated with and outcomes of open conversion after laparoscopic minor hepatectomy: initial experience at a single institution

“…The clinicopathological features and operative outcomes of the patients are summarized in Tables 1 and 2. Four patients had LMH for emergency indications including two for ruptured HCC [18,19] and 2 for liver abscess. The Pringle's maneuver was applied in 21 patients and the median duration of inflow occlusion in these patients was 42 (range 5-148) min.…”

Early experience with laparoscopic liver resection for spontaneously ruptured hepatocellular carcinoma

“…Concerns include difficult visualisation, suboptimal exposure and prolonged operating times. [ 11 ] Patient safety is of utmost importance; and hence, we were very careful in our selection process and only performed LLR in haemodynamically stable patients with good liver function, with tumours in easily accessible locations and low difficulty scores for LLR. [ 29 ] HALS was also employed in one of our cases, whereby the surgeon's hand was instrumental in rapid evacuation of clots for improved visualisation and optimising exposure, and also allowed manual compression of the liver to decrease blood loss.…”

“…[ 29 ] HALS was also employed in one of our cases, whereby the surgeon's hand was instrumental in rapid evacuation of clots for improved visualisation and optimising exposure, and also allowed manual compression of the liver to decrease blood loss. [ 11 ] Performing major resections in patients with srHCC who often have borderline liver function carries an extremely high risk of morbidity and mortality,[ 10 ] hence we restricted ourselves in this early experience to minor hepatectomies. Very recently, Yoshiya et al .…”

“…Two of these cases were reported previously. [ 11 12 ] These patients were matched 1:2 against 10 patients, selected from a cohort of 78 patients who underwent open liver resection (OLR) for srHCC,[ 14 ] based on tumour location, type of surgery, presence of cirrhosis and tumour size. The five patients were also compared against a matched cohort of 18 patients who underwent LLR for non-ruptured HCC (nrHCC) by the same surgeon.…”

“…The role of laparoscopic resection for ruptured liver tumours is still very limited and has only been discussed in a few case reports. [ 10 11 12 13 ] Owing to the paucity of data regarding LLR for spontaneously ruptured HCC (srHCC), we performed this study to determine the safety and feasibility of LLR for srHCC by analysing our experience with the procedure.…”