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Updated: Aug 18, 2026
Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver
Published on: June 16, 2023
[Laparoscopic liver resection without a Pringle maneuver for HCC in cirrhotic patients]
Giulio Belli1, Corrado Fantini, Alberto D'Agostino
1UO Chirurgia Generale ed Epatobiliopancreatica, Ospedale S. Maria Loreto Nuovo, Napoli.
Insights
Minimally invasive laparoscopic liver resection is a safe and feasible option for treating early-stage hepatocellular carcinoma (HCC) in patients with well-compensated cirrhosis. Careful patient selection is key to successful outcomes.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Techniques
- Hepatocellular Carcinoma (HCC) Research
Context:
- Cirrhosis patients with hepatocellular carcinoma (HCC) often present complex surgical challenges.
- Minimally invasive approaches offer potential advantages in liver surgery, especially for patients with liver disease.
- Evaluating the safety and efficacy of laparoscopic liver resection in this specific patient group is crucial.
Purpose:
- To assess the feasibility and safety of laparoscopic liver resection for HCC in patients with well-compensated cirrhosis (Child-Pugh class A).
- To evaluate short-term and long-term outcomes, including morbidity, mortality, and recurrence rates.
Summary:
- Sixteen patients with well-compensated HCV-related liver cirrhosis and HCC underwent laparoscopic liver resection.
- Procedures included non-anatomical resections, a VI segmentectomy, and a left lobectomy, with one conversion to laparotomy.
- Outcomes showed no blood transfusions required, one death from respiratory distress syndrome, and two cases of ascites.
- Mean follow-up of 18 months revealed no recurrence at resection sites or port-site metastases.
Impact:
- Laparoscopic liver resection for HCC in selected cirrhotic patients is technically feasible and safe.
- Careful selection criteria (limited hepatic involvement, tumor size <5cm, Child-Pugh A) are essential for successful outcomes.
- This study supports the adoption of minimally invasive techniques in managing HCC in cirrhotic patients, potentially improving patient recovery.
Abstract:
In the belief that the advantages stemming from a minimally invasive approach are significant, particularly in cirrhosis patients, we decided to apply this technique in the treatment of a group of patients suffering from HCC associated with cirrhosis. Sixteen patients (10 men, 6 women; mean age 60.1 years) underwent laparoscopic surgery for HCC associated with well compensated HCV-related liver cirrhosis (Child-Pugh class A; mean tumour size 2.9 cm). Seven of these lesions were located in the left liver and 9 in the right lobe. Laparoscopy was performed with a CO2 pneumoperitoneum (12-14 mmHg). The Pringle manoeuvre was not used. There was one conversion to laparotomy due to inadequate exposure. We performed 13 non-anatomical resections, 1 VI segmentectomy and 1 anatomical left lobectomy. None of the patients required blood transfusions. One patient died of severe respiratory distress syndrome on postoperative day 3. Major morbidity included 2 moderate postoperative ascites successfully resolved with conservative treatment. To date (mean follow-up: 18 months) no recurrences at the resection site or port-site metastases have been observed. Limited laparoscopic liver resections for HCC in cirrhotic patients are technically feasible and safe when careful selection criteria are adopted (hepatic involvement limited and located in the left or anterior right segments, tumour size smaller than 5 cm, Child-Pugh class A).
