title: Laparoscopy-assisted major liver resections employing a hanging technique: the original procedure.
abstract: OBJECTIVE
  To assess the feasibility, safety, and short-term outcomes of laparoscopy-assisted major liver resections.
  
  
  BACKGROUND
  The number of reports of laparoscopic major hepatectomies has gradually increased, and living donor hepatectomies for liver transplant have also recently been performed. However, because of the high degree of proficiency required, major hepatectomies have not been widespread. We developed an original procedure in which the liver is mobilized laparoscopically and resected by a hanging technique through a small incision.
  
  
  METHODS
  Between November 2002 and December 2008, 43 patients underwent laparoscopy-assisted major liver resections (LAMLRs) in our institution for hepatocellular carcinoma, metastatic liver cancer, and benign diseases.
  
  
  RESULTS
  LAMLRs were completed for 42 patients (97.7%). The median age was 62 years (range: 24-83 years). Preoperative diagnoses were hepatocellular carcinoma (n = 15), metastatic liver cancer (n = 19), and benign disease (n = 8). The types of liver resection consisted of the following: right trisectionectomy (n = 2), right hepatectomy (n = 14), left hepatectomy (n = 16), trisegmentectomy 4, 5, 8 (n = 2), right anterior sectionectomy (n = 4), and extended right posterior sectionectomy (n = 4). The median operating time was 317 minutes (range: 192-542 minutes) and median blood loss was 631 mL (range: 68-2785 mL). There were neither perioperative deaths nor reoperations. Five patients (11.9%) experienced postoperative complications, 2 patients (4.8%) showed bile leakage, and 3 patients (7.1%) developed wound infections. The median postoperative hospital stay was 13.5 days (range: 6-154 days).
  
  
  CONCLUSIONS
  LAMLR with the hanging technique can be completed safely. The procedure can be performed by open liver surgeons; and thus may be widely performed in the future.
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan. hnitta@iwate-med.ac.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nitta
authors.forename: Akira
authors.initials: A
authors.lastname: Sasaki
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Fujita
authors.forename: Hidenori
authors.initials: H
authors.lastname: Itabashi
authors.forename: Koichi
authors.initials: K
authors.lastname: Hoshikawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Takahara
authors.forename: Masahiro
authors.initials: M
authors.lastname: Takahashi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nishizuka
authors.forename: Go
authors.initials: G
authors.lastname: Wakabayashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult