title: Completely laparoscopic nonanatomic hepatic resection using saline-cooled cautery and hydrodissection.
abstract: The technical aspects of laparoscopic hepatic resection have evolved rapidly. The key to any approach is establishing a reliable method to prevent or control hemorrhage during parenchymal transection. Although combining a hand-assist technique with laparoscopy allows improved control of bleeding risk, this requires the addition of a hand-port incision. The development of novel devices that can be used to safely divide liver parenchyma laparoscopically may lessen the need for hand-assist. Here, we report a series of laparoscopic hepatic resections that were attempted without the use of hand-assistance (completely laparoscopic). Resections were performed using saline-cooled cautery (Tissue-Link Endohook) and/or hydrodissection (Erbe Helix Hydrojet). Fifteen laparoscopic hepatic resections were attempted by a single surgeon from 2002 to 2006. In each case, a nonanatomic, completely laparoscopic approach was attempted. Patients with lesions at the hepatic dome or those requiring lobectomy or hilar dissection were excluded. Fourteen of 15 cases (93%) were accomplished completely laparoscopically, while one patient required placement of a hand port. Resected tumors averaged 3.9 cm diameter. There were no bile leaks and no patient required transfusion. Average length of stay was 4.1 days (range 1-5). Complications included ileus (1) and atrial fibrillation (1). In six patients with malignancies, margins were negative and there have been no local or port recurrences. This report demonstrates the feasibility of completely laparoscopic hepatic resection using novel devices for parenchymal transaction. Hand-assist techniques remain useful as a salvage strategy or for larger resections.
authors.affiliation: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. Nicholas.nissen@cshs.org
authors.forename: Nicholas N
authors.initials: NN
authors.lastname: Nissen
authors.forename: Navanjun
authors.initials: N
authors.lastname: Grewal
authors.forename: Joseph
authors.initials: J
authors.lastname: Lee
authors.forename: Atta
authors.initials: A
authors.lastname: Nawabi
authors.forename: Jeremy
authors.initials: J
authors.lastname: Korman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000379:methods; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008113:Liver Neoplasms; D008297:Male; D008875:Middle Aged; D012965:Sodium Chloride; D014867:Water
chemical_list: D014867:Water; D012965:Sodium Chloride