Laparoscopic liver resection in the semiprone position for tumors in the anterosuperior and posterior segments, using a novel dual-handling technique and bipolar irrigation system

Abstract

BackgroundHepatic tumors in the lower edge and lateral segments are commonly treated by laparoscopic liver resection. Tumors in the anterosuperior and posterior segments are often large and locally invasive, and resection is associated with a higher risk of insufficient surgical margins, massive intraoperative bleeding, and breaching of the tumor. Laparoscopic surgery for such tumors often involves major hepatectomy, including resection of a large volume of normal liver tissue. We developed a novel method of laparoscopic resection of tumors in these segments with the patient in the semiprone position, using a dual-handling technique with an intercostal transthoracic port. The aim of this study was to evaluate the safety and usefulness of our technique.MethodsOf 160 patients who underwent laparoscopic liver resection at our center from June 2008 to May 2013, we retrospectively reviewed those with tumors in the anterosuperior and posterior segments. Patients were placed supine or semilateral during surgery until January 2010 and semiprone from February 2010.ResultsBefore the introduction of the semiprone position in February 2010, a total of 7 of 40 patients (17.5 %) with tumors in the anterosuperior and posterior segments underwent laparoscopic liver resection, and after introduction of the semiprone position, 69 of 120 patients (57.5 %) with tumors in the anterosuperior and posterior segments underwent laparoscopic liver resection (P < 0.001). There were no conversions to open surgery, reoperations, or deaths. The semiprone group had a significantly higher proportion of patients who underwent partial resection or segmentectomy of S7 or S8, lower intraoperative blood loss, and shorter hospital stay than the supine group (all P < 0.05). Postoperative complication rates were similar between groups.ConclusionsLaparoscopic liver resection in the semiprone position is safe and increases the number of patients who can be treated by laparoscopic surgery without increasing the frequency of major hepatectomy.Electronic supplementary materialThe online version of this article (doi:10.1007/s00464-014-3469-y) contains supplementary material, which is available to authorized users.

Long-Term Favorable Surgical Results of Laparoscopic Hepatic Resection for Hepatocellular Carcinoma in Patients with Cirrhosis: A Single-Center Experience over a 10-Year Period

“…From June 2008 in 38 patients (60%), pure Lap-Hx was introduced in our institution, 6 and Lap-Hx for the posterior segment, anterosuperior segment (S8), and caudate lobe was performed with the patient in the semiprone position. 7,8 In patients who underwent the Lap-Hx, bipolar scissors or a Biclamp under the VIO soft-coagulation system (ERBE Elektromedizin) fitted with a silicon tube dropping saline to the tip was used to transect the liver parenchyma. If transection of the liver parenchyma of S7, S8, or the right superior portion of S1 was needed in the Lap-Hx patients, an intracostal port with a balloon was placed under left-lung ventilation.…”

“…5 In June 2008, pure Lap-Hx was introduced in our institution, 6 and Lap-Hx for the posterior segment, anterosuperior segment (S8), and caudate lobe was performed with the patient in the semiprone position. 7,8 Several meta-analyses summarized the surgical results of Lap-Hx for HCC as follows: less blood loss, less frequent need for transfusion, less morbidity, a lower complication rate of ascites, a lower complication rate of liver failure, shorter hospital stays, and no compromise in prognosis. [9][10][11][12][13] However, long-term (ie, more than 10 years) surgical results of Lap-Hx for HCC in patients with cirrhosis have not yet been reported.…”

Laparoscopic liver resection: the current status and the future

“…It was recommended as a routine liver surgery by the 1 st international expert consensus on laparoscopic liver resection in 2008 (2). Procedures including isolated caudate lobectomy, trisegmentectomy and middle hepatic lobectomy (segments 4, 5, and 8) are rarely performed even in experienced institute for the technique difficult and the risk of massive bleeding (25,26). For the tumor located in segment VII and VIII, normal laparoscopic instruments are difficult to reach.…”

Radical Robot-Assisted Liver Resection for Alveolar Echinococcosis

“…The mean operative time, even in expert hands, can reach 344 minutes (range, 99 -685). 10 Technical improvement depends on the learning curve, which usually includes not less than 20 -30 similar procedures in laparoscopic liver surgery. 19 …”