Pure laparoscopic hepatectomy for hepatocellular carcinoma with chronic liver disease.
Pure laparoscopic hepatectomy is a less invasive procedure than conventional open hepatectomy for the resection of hepatic lesions. Increases in experiences with the technique, in combination with advances in technology, have promoted the popularity of pure laparoscopic hepatectomy. However, indications for usage and potential contraindications of the procedure remain unresolved. The characteristics and specific advantages of the procedure, especially for hepatocellular carcinoma (HCC) patients with chronic liver diseases, are reviewed and discussed in this paper. For cirrhotic patients with liver tumors, pure laparoscopic hepatectomy minimizes destruction of the collateral blood and lymphatic flow from laparotomy and mobilization, and mesenchymal injury from compression. Therefore, pure laparoscopic hepatectomy has the specific advantage of minimal postoperative ascites production that leads to lowering the risk of disturbance in water or electrolyte balance and hypoproteinemia. It minimizes complications that routinely trigger postoperative serious liver failure. Under adequate patient positioning and port arrangement, the partial resection of the liver in the area of subphrenic space, peri-inferior vena cava area or next to the attachment of retro-peritoneum is facilitated in pure laparoscopic surgery by providing good vision and manipulation in the small operative field. Furthermore, the features of reduced post-operative adhesion, good vision, and manipulation within the small area between the adhesions make this procedure safer in the context of repeat hepatectomy procedures. These improved features are especially advantageous for patients with liver cirrhosis and multicentric and/or metachronous HCCs.
Zenichi Morise, Norihiko Kawabe, Jin Kawase, Hirokazu Tomishige, Hidetoshi Nagata, Hisanori Ohshima, Satoshi Arakawa, Rie Yoshida, Masashi Isetani, Department of Surgery, Fujita Health University School of Medicine, Banbuntane Houtokukai Hospital, Aichi 454-8509, Japan.
Zenichi
Z
Morise
Norihiko
N
Kawabe
Jin
J
Kawase
Hirokazu
H
Tomishige
Hidetoshi
H
Nagata
Hisanori
H
Ohshima
Satoshi
S
Arakawa
Rie
R
Yoshida
Masashi
M
Isetani
Ascites; Bridging therapy to transplantation; Chronic liver disease; Hepatocellular carcinoma; Laparoscopic hepatectomy; Liver Tumor; Liver cirrhosis; Liver resection; Postoperative liver failure; Repeat hepatectomy