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Annals of Surgical Oncology

, Volume 24, Issue 2, pp 554–555 | Cite as

Laparoscopic Right Hepatectomy: Toward Protocolization and Simplification

  • Sung Hoon Choi
  • Gi Hong ChoiEmail author
  • Dai Hoon Han
  • Sung Won Kwon
  • Jin Sub Choi
Hepatobiliary Tumors

Abstract

Background

Major hurdles for laparoscopic right hepatectomy (LapRH) include difficulties in (1) mobilization and (2) applying hanging maneuver and (3) lack of experienced assistants. We discuss the protocolization of lapRH, introducing our simplified technique.

Methods

The procedure was disassembled into six steps: (1) curtailed mobilization of the right liver so as to align the resection plane with the laparoscopic camera view, (2) inflow vascular control, (3) setting up the parenchymal resection applying the rubber band retraction method, (4) parenchymal resection approaching the caudate lobe, (5) a lifting-up maneuver using a laparoscopic grasper or retractor instead of the hanging maneuver, and (6) completion of resection dividing the caudate lobe, right hepatic vein, and remaining ligament.

Results

Between March 2014 and August 2015, 13 LapRH surgeries were attempted. The patients consisted of eight males and five females with a mean age of 58.5 ± 11.6 years. Final pathological diagnoses were hepatocellular carcinoma in seven patients, intrahepatic duct stone in 4, and colorectal liver metastasis in 2. The mean total operative time was 381 ± 66 minutes, and the mean intraoperative estimated blood loss was 633 ± 619 ml. One patient was converted to open surgery. There was no clinically significant complication, and the mean length of stay after surgery was 9.1 ± 2.3 days.

Conclusions

Protocolization and simplification of the procedure may allow professionals to better understand the respective process and determine appropriate port placements, resulting in safe and successful minimally invasive hepatectomy procedures.

Supplementary material

Supplementary material 1 (WMV 248697 kb)

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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Sung Hoon Choi
    • 1
  • Gi Hong Choi
    • 2
    • 3
    Email author
  • Dai Hoon Han
    • 2
  • Sung Won Kwon
    • 1
  • Jin Sub Choi
    • 2
  1. 1.Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical CenterCHA UniversitySeongnamKorea
  2. 2.Division of Hepatobiliary and Pancreas, Department of SurgeryYonsei University College of MedicineSeoulKorea
  3. 3.Department of SurgeryYonsei University Health SystemSeoulKorea

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