title: [Right hepatectomy and left hepatectomy performed via hand-assisted laparoscopic surgery. Description of an original technique].
abstract: BACKGROUND
  Laparoscopic liver surgery in solid tumors presents a number of difficulties. This type of surgery is indicated especially in tumors of less than 5 cm located in the left lobe and in anterior segments of the right lobe. Access to posterior lesions of the right lobe (segments VII and VIII) and performing major regulated hepatectomies (more than 3 segments) are at present difficult for liver surgeons.
  
  
  OBJECTIVE
  To present a regulated right hepatectomy (RH) and left hepatectomy (LH) performed via hand-assisted laparoscopic surgery (HALS) using an original technique.
  
  
  METHODS
  RH was performed in a 70-year-old man with hepatic metastases from colorectal carcinoma (pT2N0M1 sigmoid adenocarcinoma). LH was performed in a 44-year-old woman with a 16-cm hemangioma that had shown tumoral growth. Dissection of the hepatic artery was performed between ligations, and the portal vein was sectioned between ligations or with a vascular endostapler. Division of the bile duct and suprahepatic veins was performed with a vascular endostapler. Parenchymal dissection was carried out with a harmonic scalpel and dissection of intrahepatic veins of over 3 mm was performed with a 10-mm Ligasure Atlas.
  
  
  RESULTS
  The operating time for RH was 360 min, with no transfusion or complications, and length of hospital stay was 5 days. The operating time for LH was 240 min, requiring 2 U of blood, with no morbidity and a length of hospital stay of 4 days.
  
  
  CONCLUSIONS
  HALS allows major liver resections to be performed with low morbidity and mortality and with the advantages of laparoscopic surgery.
authors.affiliation: Departamento de Cirugía, Unidad de Cirugía Hepática y Trasplante Hepático, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España. rirocam@um.es
authors.forename: Ricardo
authors.initials: R
authors.lastname: Robles
authors.forename: Caridad
authors.initials: C
authors.lastname: Marín
authors.forename: Beatriz
authors.initials: B
authors.lastname: Abellán
authors.forename: Asunción
authors.initials: A
authors.lastname: López-Conesa
authors.forename: Pablo
authors.initials: P
authors.lastname: Ramírez
authors.forename: Pascual
authors.initials: P
authors.lastname: Parrilla
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006391:Hemangioma / Q000473:pathology* / Q000601:surgery; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D008297:Male; D011183:Postoperative Complications; D016896:Treatment Outcome