Standardization of basic skills for laparoscopic liver surgery towards laparoscopic donor hepatectomy.
BACKGROUND
We have accumulated over 170 patients since 1995 who underwent laparoscopic partial liver resection, laparoscopic left lateral sectionectomy, and laparoscopy-assisted hepatectomy. Bleeding control, which is a basic element of liver resection, needs to be better managed by methods suitable for safer laparoscopic liver resection. The aim of this study was to standardize the basic skills and to establish safer techniques for laparoscopic liver surgery in order to perform safe laparoscopic donor hepatectomy.


METHODS
We analyzed initial results from the viewpoint of operative techniques of laparoscopic liver resection in our series. Laparoscopic liver resections have been successfully performed by the application of automatic suturing devices and the radiofrequency method.


RESULTS
We have performed 105 laparoscopic partial liver resections, 26 laparoscopic left lateral sectionectomies, and 45 laparoscopy-assisted major hepatectomies. A total of 176 patients underwent minimally invasive liver resections.


CONCLUSIONS
For safer laparoscopic liver resection, efficient bleeding control techniques, such as radiofrequency pre-coagulation and the liver hanging maneuver, are needed during parenchymal transection of the liver. Laparoscopy-assisted donor hepatectomy can be safely performed without increasing operative risks with mini-laparotomy.
Wakabayashi
Go
G
Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan. gowaka@iwate-med.ac.jp
Nitta
Hiroyuki
H
Takahara
Takeshi
T
Shimazu
Motohide
M
Kitajima
Masaki
M
Sasaki
Akira
A
D016063:Blood Loss, Surgical; D002983:Clinical Competence / Q000592:standards*; D006498:Hepatectomy / Q000379:methods* / Q000592:standards; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000592:standards; D017075:Laser Coagulation; D014019:Tissue Donors; D016896:Treatment Outcome