Detailed Abstract
[Liver Best Oral Presentation - Liver (Liver Disease/Surgery)]
[LV BO-S5] Laparoscopy Specific Dorsal Approaching Procedures to the Middle Hepatic Vein in Performing Left Hemihepatectomy: Image of Writing Japanese Hiragana Character “の“
Masaki UENO 1, Shinya HAYAMI 1, Atsushi MIYAMOTO 1, Ken-ichi OKADA 1, Yuji KITAHATA 1, Atsushi SHIMIZU 1, Hideki MOTOBAYASHI 1, Kyohei MATSUMOTO 1, Manabu KAWAI 1
1 Second Department of Surgery, Wakayama Medical University, JAPAN
Background : Laparoscopic surgery can provide a surgical view that cannot be obtained by open surgery. Herein, we report surgical procedures of laparoscopic left hemi-hepatectomy by the laparoscopy specific dorsal approaching method.
Methods : Surgical procedures are similar to writing the Japanese hiragana character "の" as follows; (1) Flip-up the left lateral segment and start liver transection from the Arantius plate around the root of left hepatic vein (LHV) to approach the middle hepatic vein (MHV). The distance from Arantius plate to MHV is around 1cm and therefore quickly we can approach to the MHV. (2) Encircle and cut the left Glissonean branch. Grasp the stump and flip it up, continue liver resection with exposing the MHV toward its periphery direction. (3) After exposing the MHV, flip down the left-lateral segment to the original position and transect the liver parenchyma remaining on the ventral side of the MHV from caudal to cranial direction. (4) Finally, cut the LHV by a linear stapler device.
Results : This technique was performed for 21 consecutive patients. Median (25, 75percentile) values of the blood loss and operating time were 65 (50, 100) ml and 302 (287, 328) minutes, respectively. Excellent MHV appearance on the cutting-surface was observed in all cases. There were no severe postoperative complications.
Conclusions : This procedure enables us to approach the MHV easily and also enables us to avoid split injuries of venous branches during the MHV exposing. This procedure may be a theoretical method in performing laparoscopic left hemihepatectomy.
Methods : Surgical procedures are similar to writing the Japanese hiragana character "の" as follows; (1) Flip-up the left lateral segment and start liver transection from the Arantius plate around the root of left hepatic vein (LHV) to approach the middle hepatic vein (MHV). The distance from Arantius plate to MHV is around 1cm and therefore quickly we can approach to the MHV. (2) Encircle and cut the left Glissonean branch. Grasp the stump and flip it up, continue liver resection with exposing the MHV toward its periphery direction. (3) After exposing the MHV, flip down the left-lateral segment to the original position and transect the liver parenchyma remaining on the ventral side of the MHV from caudal to cranial direction. (4) Finally, cut the LHV by a linear stapler device.
Results : This technique was performed for 21 consecutive patients. Median (25, 75percentile) values of the blood loss and operating time were 65 (50, 100) ml and 302 (287, 328) minutes, respectively. Excellent MHV appearance on the cutting-surface was observed in all cases. There were no severe postoperative complications.
Conclusions : This procedure enables us to approach the MHV easily and also enables us to avoid split injuries of venous branches during the MHV exposing. This procedure may be a theoretical method in performing laparoscopic left hemihepatectomy.
SESSION
Liver Best Oral Presentation
Room B 3/22/2024 1:30 PM - 2:50 PM