Satoshi Ogiso1,2, Takeo Nomi3,4, Kenichiro Araki3,5, Claudius Conrad3,6, Etsuro Hatano7, Shinji Uemoto7, David Fuks3, Brice Gayet8. 1. Department of Digestive Pathology, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France. oggy_so@ybb.ne.jp. 2. Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. oggy_so@ybb.ne.jp. 3. Department of Digestive Pathology, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France. 4. Department of Surgery, Nara Medical University, Nara, Japan. 5. Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan. 6. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 7. Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 8. Department of Digestive Pathology, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France. Brice.Gayet@imm.fr.
Abstract
BACKGROUND: Despite diffusion of laparoscopic hepatectomy, the acquisition of necessary skills is not easy for open liver surgeons. Concepts and techniques have totally changed in laparoscopic hepatectomy compared with open hepatectomy, which is an underlying cause of a technical hurdle in laparoscopic hepatectomy. This study aimed to illustrate laparoscopy-specific concepts and techniques for hepatectomy. METHODS: Video footages of laparoscopic and open hepatectomies stored in the Institut Mutualiste Montsouris and Kyoto University were reviewed to define the differences in surgical view, surgical concept, and technical details, using left lateral sectionectomy (LLS) and right hepatectomy (RH) as representative examples. RESULTS: By comparison with open LLS and RH, laparoscopy-specific procedures were identified with regard to surgical view, parenchymal transection, available landmarks, and vascular dissection. By laparoscopy, the surgical field was constantly viewed and accessed from the caudal side to the cranial side. Similarly, the parenchyma was divided, and intrahepatic vessels were dissected in the same direction. Laparoscopy-specific landmarks were identified for both LLS and RH, behind the liver. CONCLUSIONS: The concepts and techniques in laparoscopic hepatectomy are totally different from those of open hepatectomy because of the different surgical views. Understanding the laparoscopy-specific concepts and techniques would facilitate safe and efficient execution of laparoscopic hepatectomy.
BACKGROUND: Despite diffusion of laparoscopic hepatectomy, the acquisition of necessary skills is not easy for open liver surgeons. Concepts and techniques have totally changed in laparoscopic hepatectomy compared with open hepatectomy, which is an underlying cause of a technical hurdle in laparoscopic hepatectomy. This study aimed to illustrate laparoscopy-specific concepts and techniques for hepatectomy. METHODS: Video footages of laparoscopic and open hepatectomies stored in the Institut Mutualiste Montsouris and Kyoto University were reviewed to define the differences in surgical view, surgical concept, and technical details, using left lateral sectionectomy (LLS) and right hepatectomy (RH) as representative examples. RESULTS: By comparison with open LLS and RH, laparoscopy-specific procedures were identified with regard to surgical view, parenchymal transection, available landmarks, and vascular dissection. By laparoscopy, the surgical field was constantly viewed and accessed from the caudal side to the cranial side. Similarly, the parenchyma was divided, and intrahepatic vessels were dissected in the same direction. Laparoscopy-specific landmarks were identified for both LLS and RH, behind the liver. CONCLUSIONS: The concepts and techniques in laparoscopic hepatectomy are totally different from those of open hepatectomy because of the different surgical views. Understanding the laparoscopy-specific concepts and techniques would facilitate safe and efficient execution of laparoscopic hepatectomy.