[Laparoscopic left lateral segmentectomy of the liver: indications, technique, results]

The laparoscopic approach of the hepatic lesions located in the left lobe is a frequently used procedure in liver surgery for both benign and malign tumors because of the minimal invasive character, anatomical particularities and modem devices used in hemostasis and biliary-stasis. The purpose of this study is to analyze our experience and report it to the literature data.

The study starts from the basic indications of laparoscopic left lateral segmentectomy, it emphasizes the main operating steps and analyzes the results of this method in a cohort retrospective study in which we included all the laparoscopic resections performed in our center between 1998-2007, both laparoscopic and hand-assisted laparoscopic procedures. We excluded exploratory laparoscopies and the cases in which after the tumor exploration, we decided conversion to open approach in the absence of any intraoperative incidents.

Between 1998-2007 we performed 84 laparoscopic hepatic resections out of which 20 were located in the left liver lobe. There were 12 left lateral segmentectomy and in 4 cases we used hand assisted laparoscopy due to bigger tumour dimensions. The hepatic lesions approached laparoscopically were both benign (5 cases out of which 3 hemangioma and 2 adenoma) and malignant (7 cases hepatocellular carcinoma). The tumor diameter ranged between 2-10 cm. The Pringle manoeuvre was never used.

Left lateral segmentectomy can be routinely performed laparoscopically in the absence of any contraindications. This intervention can be accurately performed respecting the limits of oncological security. The results obtained in our center are in accordance with the literature and emphasize the advantages of the minimal invasive approach. On a medium and long term, the results are comparable with those obtained in open surgery.