Major vessel injury during extraglissonean approach of left pedicle for left hepatectomy fully controlled laparoscopically

Abstract

Although laparoscopic surgery has been widely adopted for also Hepato-biliary-pancreatic surgery, laparoscopic resection of hilar cholangiocarcinoma remains uncommon because of its difficult procedures consisted of major hepatectomy, lymph node dissection and biliary reconstruction. Methods: The patient was placed in left hemilateral position and five laparoscopic trocars were positioned. The right lobe and the caudate lobe were completely mobilized. After the Kocher maneuver, lymphadenectomy was performed using LCS. Then the common bile duct, the right hepatic artery and the right portal vein were divided. A hepatic parenchymal transection was performed by BiClamp using a modified hanging maneuver and the right hepatic vein was divided using a linear stapler. The left hepatic duct was divided adjacent to the umbilical portion and the specimen was retrieved through the minilaparotomy. End-to-side endoscopic hepaticojejunostomy was performed with running sutures. Results: From October 2012 through November 2014, three patients with hilar cholangiocarcinoma underwent laparoscopic extended right hepatectomy with biliary reconstruction. The median operative time was 867 min (range, 853e1010 min), and median estimated blood loss was 100 ml (range, 43e400 ml). The median length of hospital stay was 19 days (range, 16e23 days), and there was no postoperative mortality. Conclusions: Laparoscopic resections for hilar cholangiocarcinomas are safe and feasible in selected patients and when performed by surgeons with expertise in hepatic surgery and minimally invasive techniques. Further studies are still needed to confirm the benefit of this approach over conventional surgery for hilar cholangiocarcinoma.