title: A hybrid method of laparoscopic-assisted open liver resection through a short upper midline laparotomy can be applied for all types of hepatectomies.
abstract: BACKGROUND
  Although hepatectomy procedures should be designed to provide both curability and safety, minimal invasiveness also should be pursued.
  
  
  METHODS
  We analyzed the data related to our method for laparoscopy-assisted open resections (hybrid method) through a short upper midline incision for various types of hepatectomies. Of 215 hepatectomies performed at Nagasaki University Hospital between November 2009 and June 2012, 102 hepatectomies were performed using hybrid methods.
  
  
  RESULTS
  A hybrid method was applicable for right trisectionectomy in 1, right hemihepatectomy in 32, left hemihepatectomy in 29, right posterior sectionectomy in 7, right anterior sectionectomy in 1, left lateral sectionectomy in 2, and segmentectomy in 7 patients, and for a minor liver resection in 35 patients (12 combined resections). The median duration of surgery was 366.5 min (range 149-709) min, and the median duration of the laparoscopic procedure was 32 min (range 18-77) min. The median blood loss was 645 g (range 50-5,370) g. Twelve patients (12 %) developed postoperative complications, including bile leakage in three patients, wound infections in two patients, ileus in two patients, and portal venous thrombus, persistent hyperbilirubinemia, incisional hernia, local liver infarction each in one patient. There were no perioperative deaths.
  
  
  CONCLUSIONS
  Our method of hybrid hepatectomy through a short upper midline incision is considered to be applicable for all types of hepatectomy and is a reasonable approach with no abdominal muscle disruption, which provides safe management of the hepatic vein and parenchymal resection even for patients with bilobular disease.
authors: Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan, soyama@nagasaki-u.ac.jp.
authors: Akihiko
authors: A
authors: Soyama
authors: Mitsuhisa
authors: M
authors: Takatsuki
authors: Tomohiko
authors: T
authors: Adachi
authors: Amane
authors: A
authors: Kitasato
authors: Yasuhiro
authors: Y
authors: Torashima
authors: Koji
authors: K
authors: Natsuda
authors: Takayuki
authors: T
authors: Tanaka
authors: Izumi
authors: I
authors: Yamaguchi
authors: Shiro
authors: S
authors: Tanaka
authors: Ayaka
authors: A
authors: Kinoshita
authors: Tamotsu
authors: T
authors: Kuroki
authors: Susumu
authors: S
authors: Eguchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods*; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome; D055815:Young Adult
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