BACKGROUND/AIMS: It is important to minimize surgical invasiveness in the therapy of patients with hepatocellular carcinoma (HCC) complicated with cirrhosis. Laparoscopic hepatectomy is feasible for such patients. However, most procedures undertaken at the present time are non-anatomic partial resection or limited resection, except for left hepatectomy and bisegmentectomy 2 and 3. Because anatomic hepatic resection for small HCC yielded more favorable results than non-anatomic resection, we conducted laparoscopic anatomic hepatic resection as image-navigated surgery by referring to portal 3D images. METHODOLOGY: Detailed descriptions of laparoscopic anatomic resection, such as segmentectomy and subsegmentectomy are presented. Preoperative 3D images clarified the anatomical relationships between HCC and its portal territory and enabled determination of the transection line. Laparoscopic anatomic resection was completed with mini-laparotomy or -thoracotomy with equal success to the conventional procedure under an open approach. RESULTS: Five patients with primary HCC with cirrhosis underwent the above procedure between January 2008 and February 2009. There were 2 male and 3 female patients, with a median age of 74.4 (70-80) years. All procedures were successful, with no conversions to open surgery required. The median operation time was 251 min (range: 222-280 min), and the median estimated blood loss was 183 ml (range 50-320 ml). There was no surgical mortality and major morbidity. CONCLUSIONS: These procedures contributed reduced invasiveness, even for elderly patients with cirrhosis: low blood loss and no postoperative complication. Laparoscopic anatomic hepatic resection based on navigation of the portal 3D images might be useful not only to facilitate minimally invasive surgery but also to improve the therapeutic efficacy.
BACKGROUND/AIMS: It is important to minimize surgical invasiveness in the therapy of patients with hepatocellular carcinoma (HCC) complicated with cirrhosis. Laparoscopic hepatectomy is feasible for such patients. However, most procedures undertaken at the present time are non-anatomic partial resection or limited resection, except for left hepatectomy and bisegmentectomy 2 and 3. Because anatomic hepatic resection for small HCC yielded more favorable results than non-anatomic resection, we conducted laparoscopic anatomic hepatic resection as image-navigated surgery by referring to portal 3D images. METHODOLOGY: Detailed descriptions of laparoscopic anatomic resection, such as segmentectomy and subsegmentectomy are presented. Preoperative 3D images clarified the anatomical relationships between HCC and its portal territory and enabled determination of the transection line. Laparoscopic anatomic resection was completed with mini-laparotomy or -thoracotomy with equal success to the conventional procedure under an open approach. RESULTS: Five patients with primary HCC with cirrhosis underwent the above procedure between January 2008 and February 2009. There were 2 male and 3 female patients, with a median age of 74.4 (70-80) years. All procedures were successful, with no conversions to open surgery required. The median operation time was 251 min (range: 222-280 min), and the median estimated blood loss was 183 ml (range 50-320 ml). There was no surgical mortality and major morbidity. CONCLUSIONS: These procedures contributed reduced invasiveness, even for elderly patients with cirrhosis: low blood loss and no postoperative complication. Laparoscopic anatomic hepatic resection based on navigation of the portal 3D images might be useful not only to facilitate minimally invasive surgery but also to improve the therapeutic efficacy.
Authors: T F Greten; N P Malek; S Schmidt; J Arends; P Bartenstein; W Bechstein; T Bernatik; M Bitzer; A Chavan; M Dollinger; D Domagk; O Drognitz; M Düx; S Farkas; G Folprecht; P Galle; M Geißler; G Gerken; D Habermehl; T Helmberger; K Herfarth; R T Hoffmann; M Holtmann; P Huppert; T Jakobs; M Keller; J Klempnauer; F Kolligs; J Körber; H Lang; F Lehner; F Lordick; A Lubienski; M P Manns; A Mahnken; M Möhler; C Mönch; P Neuhaus; C Niederau; M Ocker; G Otto; P Pereira; G Pott; J Riemer; K Ringe; U Ritterbusch; E Rummeny; P Schirmacher; H J Schlitt; K Schlottmann; V Schmitz; A Schuler; H Schulze-Bergkamen; D von Schweinitz; D Seehofer; H Sitter; C P Straßburg; C Stroszczynski; D Strobel; A Tannapfel; J Trojan; I van Thiel; A Vogel; F Wacker; H Wedemeyer; H Wege; A Weinmann; C Wittekind; B Wörmann; C J Zech Journal: Z Gastroenterol Date: 2013-11-15 Impact factor: 2.000