title: Totally laparoscopic hepatectomy exposing the major vessels.
abstract: BACKGROUND
  Even during laparoscopic hepatectomy, a technique is often required to expose the major vessels, for example, in anatomical hepatectomy. We have standardized and performed such laparoscopic hepatectomy as successfully as open hepatectomy.
  
  
  METHODS
  We divide the liver parenchyma without pre-coagulation, exposing the major vessels using CUSA. To control the bleeding, we keep the central venous pressure low and often perform Pringle's maneuver. Over 49 months, we performed totally laparoscopic hepatectomies in 41 patients with the technique of exposing the major vessels. These included major hepatectomy in 7, sectorectomy in 17, segmentectomy in 14, and others in 3.
  
  
  RESULTS
  The median operative time was 361 (range 176-605) minutes, with median blood loss of 216 (range 0-1600) g. The conversion rate was 4.9 %. Postoperative morbidity rate was 9.8 % (prolonged ascites in 1, port site infection in 1, peroneal palsy in 2). Mortality was zero. The median length of hospital stay after surgery was 8 (range 5-28) days. No local recurrence was found at the time of writing.
  
  
  CONCLUSIONS
  By using our standardized procedure exposing the major vessels, we could raise the quality of laparoscopic hepatectomy toward the level of open hepatectomy significantly.
authors.affiliation: Department of Surgery, Tokyo Metropolitan Cancer and Infectious diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan. ghon@cick.jp
authors.forename: Goro
authors.initials: G
authors.lastname: Honda
authors.forename: Masanao
authors.initials: M
authors.lastname: Kurata
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Okuda
authors.forename: Shin
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Sosuke
authors.initials: S
authors.lastname: Tadano
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nakano
authors.forename: Keiichi
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006499:Hepatic Artery / Q000601:surgery; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007902:Length of Stay; D008099:Liver / Q000098:blood supply*; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D061646:Operative Time; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome