The Significance of Microwave Ablation in the Treatment of Primary and Metastatic Liver Cancer

Abstract

Introduction: Laparoscopic major hepatectomy is performed increasingly these days. Methods: We have devised and standardized "Arantiusfirst approach" for laparoscopic left hemihepatectomy (LLH). We report our current procedures and short-term outcomes of 20 cases of LLH. Results: Operative procedure; After the mobilization of the left lateral section, the Arantius plate is dissected from the liver parenchyma, holding the left lateral section to the ventral side. The parenchymal transection is initiated just above the Arantius duct. Then, the left and dorsal aspect of the root of the left Glissonean pedicle (Glt) is exposed. The dorsal side of the middle hepatic vein (MHV) can be also identified behind the LHV in the same view. After the dissection of the right side of the root of Glt from segment 4, Glt can be easily encircled and divided because a sufficient space has been already obtained behind Glt. The MHV is exposed continuously from the root side to the periphery in a dorsal view with the left lobe held up to the ventral side. Short-term outcomes; Three cases underwent extended LLH, and 7 did simultaneous resection of other lesions. The median operative time was 341 min (117-430 min), the blood loss was 110 mL (minimal-430 mL), and the postoperative hospital stay was 9 days (6-25 days). There were no cases of intraoperative transfusion, conversion to open surgery, severe mortality, or mortality. R0 resection was achieved in the all patients. Conclusion: "Arantius-first approach" is useful procedure utilizing a laparoscopic magnified caudo-dorsal view.