Pure laparoscopic right posterior sectionectomy using the caudate lobe-first approach
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In our process of standardizing laparoscopic right-sided anatomical hepatectomy, we found several advantages of the caudate lobe-first approach. We herein describe our standardized procedure of laparoscopic right posterior sectionectomy (Lap-RPS) using this approach.
Between January 2011 and January 2018, 31 patients underwent pure Lap-RPS in our hospital. The mean patient age was 68 years (range 47–85 years), and the number of male patients was more than that of female patients (64.5%). Of 31 patients, 20 had metastatic liver tumor, 7 had hepatocellular carcinoma, 3 had intrahepatic cholangiocellular carcinoma, and 1 had hemangioma. All 31 patients had Child–Pugh class A liver function. The surgical technique was recorded on video. Cumulative sum (CUSUM) analyses were applied to assess the learning curve.
The mean operative time was 420 min (range 263–639 min), and the mean amount of blood loss was 304 g (range 10–900 g). No procedure was converted to open surgery. Postoperative bleeding, bile leakage, hepatic failure, and mortality did not occur. CUSUM analyses showed a decrease in the operative time and blood loss after using the caudate lobe-first approach.
Our standardized procedure of Lap-RPS using the caudate lobe-first approach is not only feasible but also expected to provide an advantage for laparoscopic anatomical hepatectomy.
KeywordsLaparoscopic right posterior sectionectomy Caudate lobe-first approach
YH, GH: study design; MK, YH, MD, JY, and YO: data acquisition and analysis; YH and GH: draft and revision of the manuscript; GH: critical revisions, final approval, and accountability of the study.
Compliance with ethical standards
Goro Honda has received lecture payments from Johnson & Johnson. Yuki Homma, Masanao Kurata, Yusuke Ome, Manami Doi and Jun Yamamoto have no conflicts of interest or financial ties to disclose.
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