title: Laparoscopic hepatectomy for extrahepatic growing tumor. Surgical strategy based on extrahepatic growing index.
abstract: BACKGROUND
  This article describes the operative procedures, varying difficulties, and required instrumentation for performing laparoscopic hepatectomy (LH) on the basis of a lesion's extrahepatic growing (EG) index, as calculated by computed tomography (CT).
  
  
  METHODS
  Laparoscopic partial hepatectomy cases were divided into the following two groups: an EG tumor group (n = 11) and an intrahepatic tumor group (n = 8). The surgical procedures, operative results, and laparoscopic instrumentation for these two groups were compared based on the EG index (/cm2; maximum diameter of tumor pedicle/maximum vertical diameter of tumor/area of the tumor).
  
  
  RESULTS
  The mean operative time was significantly shorter and the mean blood loss was significantly less in the EG tumor group than in the intrahepatic tumor group. In addition, in the EG tumor group, there were significant differences in mean operative time and mean blood loss related to the values associated with the EG index (p <0.05, P <0.01). The selection of laparoscopic instruments was based on the EG index, as follows: (a) lesions with an EG index >5/cm2 underwent resection in combination with a microwave tissue coagulator and an ultrasonic surgical aspirator (13 cases, including intrahepatic tumor cases); (b) lesions with an EG index of 5-15/cm2 underwent resection in combination with a microwave tissue coagulator and laparosonic coagulating shears (four cases); (c) lesions with an EG index <%15/cm2 underwent resection with a laparoscopic linear stapler (two cases).
  
  
  CONCLUSIONS
  Our preliminary experience leads us to believe that it is useful to calculate the EG index by CT scan before formulating the technical strategy for a subsequent LH procedure.
authors.affiliation: Second Department of Surgery, Toho University, School of Medicine, 6-11-1, Omori-nishi, Ota-ku, Tokyo 143-8541, Japan. SmitoT124@aol.com
authors.forename: S
authors.initials: S
authors.lastname: Takagi
authors.forename: H
authors.initials: H
authors.lastname: Kaneko
authors.forename: T
authors.initials: T
authors.lastname: Ishii
authors.forename: A
authors.initials: A
authors.lastname: Tamura
authors.forename: K
authors.initials: K
authors.lastname: Yamazaki
authors.forename: M
authors.initials: M
authors.lastname: Yoshino
authors.forename: M
authors.initials: M
authors.lastname: Tsuchiya
authors.forename: N
authors.initials: N
authors.lastname: Joubara
authors.forename: Y
authors.initials: Y
authors.lastname: Otuka
authors.forename: T
authors.initials: T
authors.lastname: Shiba
mesh_terms: D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D001777:Blood Coagulation / Q000528:radiation effects; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001826:Body Fluids / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery*; D006391:Hemangioma / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008872:Microwaves / Q000627:therapeutic use; D008875:Middle Aged; D008954:Models, Biological; D013525:Surgical Instruments; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014464:Ultrasonic Therapy