title: Laparoscopic segmentectomy of the liver: from segment I to VIII.
abstract: OBJECTIVE
  To evaluate the surgical techniques necessary to complete total laparoscopic segmentectomy (LS) of all liver segments (I-VIII).
  
  
  BACKGROUND
  When compared to open surgery, preservation of functional hepatic volume may be more difficult during laparoscopic hepatectomy. LS is a possible alternative to hemihepatectomy, but laparoscopic surgical techniques to complete anatomically accurate segmentectomy have not yet been well established.
  
  
  METHODS
  Data of a total of 342 consecutive patients who underwent laparoscopic hepatectomy were reviewed. LS was defined as complete removal of the Couinaud's segment, in which the corresponding hepatic veins are exposed on the raw surface. The laparoscopic approach was facilitated by using intraoperative ultrasonography for each segment and by placing intercostal trocars to expose the root of the right hepatic vein for segmentectomy VII and VIII.
  
  
  RESULTS
  LS was completed in 62 patients: 36 segmentectomies (from I-VIII), 16 bisegmentectomies of the right lobe, and 10 subsegmentectomies were performed. Conversion to open surgery was required in 3 patients (IVa, VI, and VII). When 26 LS of the superior/posterior hepatic (sub)segments (I, IVa, VII, and VIII) were compared with the remaining 36 LS, the former group required a longer operation time (240 [132-390] minutes vs 155 [90-360]) minutes, P < 0.01) and showed an increased amount of blood loss (350 [20-1500] mL vs 100 [10-1100] mL, P = 0.02).
  
  
  CONCLUSIONS
  LS is feasible and has become an essential surgical technique that can minimize the loss of functional liver volume without reducing curability, although further technical advancements are needed to enhance the accuracy of the resection, especially for the superior/posterior segments.
authors.affiliation: Department of Digestive Diseases, Institut Mutualiste Montsouris, University Paris V, France.
authors.forename: Takeaki
authors.initials: T
authors.lastname: Ishizawa
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Gumbs
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.forename: Brice
authors.initials: B
authors.lastname: Gayet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008099:Liver / Q000033:anatomy & histology / Q000601:surgery*; D008297:Male; D008875:Middle Aged