Resección de tumores hepáticos sólidos por laparoscopia. Presentación de nuestra experiencia

Transarterial Chemoembolization Prior to Early Hepatocellular Carcinoma Laparoscopic Resection in Patients with Child A Cirrhosis

“…In spite of several tumours being located in a position that makes tumour resection technically more difficult, when LLR was used, mean surgical time was low (174 min, range 120-240 min), mean blood loss was scarce (220 ml, range 50-500 ml) and the Pringle maneuver was not needed. In our series, unlike other authors (14)(15)(16), the patient was placed in supine position even when the lesions were in the right lobe. In two cases we had to convert to HALLS but this was not due to bleeding, which is a factor that commonly leads to conversion in other series (24,25,28).…”

“…Following, any possible bile leaks are sutured, a haemostatic substance is applied to the surgical bed and an aspiration drain is placed on the surgical bed. The tumour specimen is extracted via a Pfannestiel incisión, without fragmenting so that the resection margins can be checked (15,16). …”

“…In cases of conversion to a (15,16), the position of the patient and the assistants is the same as with PLP. The operation is begun with a transverse incision in the right flank, 3-5 fingerwidths from the right costal edge (from the mid axillary line to the anterior axillary line).…”

“…For most authors, HCC involves several surgical difficulties for laparoscopic approach (14)(15)(16)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27), especially in the cirrhotic liver (14,18,19, 24.25) due to the increased hardness of the liver, portal hypertension and alterations in blood clotting. These difficulties make conversion to laparotomy, mainly because of hemorrhages.…”

A new approach to hand-assisted laparoscopic liver surgery

“…With laparoscopic surgery we maintained a CVP of 8-10 mmHg in the first seven resections to minimise the risk of gas embolism [14]. In the remaining 19 patients, all in the decubitus supine position, we maintained CVP between 2 and 4 mmHg.…”