Laparoscopic hepatectomy with the hook blade of ultrasonic coagulating shears and bipolar cautery with a saline irrigation system.
BACKGROUND
The number of patients who have undergone laparoscopic hepatectomy is small, and the operative procedure is not yet well established.


METHODS
We performed laparoscopic hepatectomy in eight patients, using the hook blade of ultrasonic coagulating shears, and bipolar cautery with a saline irrigation system, with minilaparotomy. The operative time, blood loss, and postoperative hospital stay of patients with laparoscopic left lateral segmentectomy were compared with these parameters in ten patients who had had a left lateral segmentectomy with laparotomy.


RESULTS
The laparoscopic hepatectomies included seven left lateral segmentectomies and one nonanatomical partial resection of the lateral segment. The mean duration of the operation in these eight patients was 181.1 +/- 44.6 min. The mean amount of blood loss was 177.6 +/- 129.1 ml. Postoperative complications consisted of two cases of bleeding. The mean postoperative hospital stay in all eight patients was 9.88 +/- 4.36 days. The mean duration of operation (185.9 +/- 46.0 min) and mean postoperative hospital stay (9.47 +/- 4.61 days) in the seven patients with laparoscopic left lateral segmentectomies were significantly shorter than these parameters (255.7 +/- 59.4 min and 24.6 +/- 8.82 days) in the ten patients who had had left lateral segmentectomies with laparotomy. The mean amount of blood loss (160.0 +/- 128.9 ml) in the laparoscopic series was less than that (318.5 +/- 192.2 days) in the patients who had had laparotomy.


CONCLUSIONS
Laparoscopic hepatectomy with the ultrasonic coagulating shears and bipolar cautery with minilaparotomy was safe, and less invasive than the open procedure, for minor hepatectomy procedures such as left lateral segmentectomy.
Kamiyama
Toshiya
T
General Surgery, Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan.
Kurauchi
Nobuaki
N
Nakagawa
Takahito
T
Nakanishi
Kazuaki
K
Kamachi
Hirohumi
H
Matsushita
Michiaki
M
Todo
Satoru
S
D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002425:Cautery / Q000295:instrumentation*; D016009:Chi-Square Distribution; D005260:Female; D006498:Hepatectomy / Q000295:instrumentation*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008107:Liver Diseases / Q000601:surgery*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012965:Sodium Chloride / Q000008:administration & dosage; D018709:Statistics, Nonparametric; D013525:Surgical Instruments; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000295:instrumentation*
D012965:Sodium Chloride