Laparoscopic hand-assisted right hemihepatectomy by ultrasound-directed intrahepatic approach.
OBJECTIVE
Laparoscopic hepatectomy is a promising option for patients affected by a liver mass, and the procedure is gaining popularity. Minor laparoscopic resections have been widely reported. In contrast, major laparoscopic hepatectomy has been performed in only a limited number of cases. Hand-assisted laparoscopic liver surgery has been advocated in order to improve liver exposure and vascular control and increase the safety of the procedure. Transparenchymal en-bloc transection of the right portal triad has been reported to be safe and useful in open surgery.


METHODS
We describe a personal technique for hand-assisted right hemihepatectomy. With ultrasound guidance, the right hepatic pedicle is isolated intrahepatically and transected en bloc with a single firing of an endostapler. Parenchymal transection is carried out with ultrasonically activated or vessel-sealing devices together with endostaplers.


RESULTS
The procedure was successfully accomplished in three patients. The Pringle maneuver was never performed. No intraoperative or postoperative complications occurred.


CONCLUSIONS
This study is the first to report a technique of right hemihepatectomy that combines hand-assisted laparoscopy and an ultrasound-guided intrahepatic approach. This technique may be a useful option to simplify the operation, reduce operative time, and increase the safety of the procedure.
Department of General and Hepato-Pancreato-Biliary Surgery, S.M. Loreto Nuovo Hospital, Naples, Italy. chirurgia.loretonuovo@tin.it
Giulio
G
Belli
Alberto
A
D'Agostino
Corrado
C
Fantini
Andrea
A
Belli
Luigi
L
Cioffi
Paolo
P
Limongelli
Gianluca
G
Russo
D000368:Aged; D001653:Bile Ducts, Intrahepatic / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008099:Liver / Q000098:blood supply / Q000000981:diagnostic imaging*; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery; D017792:Surgical Stapling / Q000379:methods; D018084:Ultrasonography, Interventional / Q000379:methods*