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Totally laparoscopic anatomic S7 segmentectomy using in situ split along the right intersectoral and intersegmental
Jun Cao1, Wen-da Li1, Rui Zhou1
1Department of Hepatobiliopancreatic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Yanjiangxi road 107#, Guangzhou, China.
Surgical Endoscopy
|January 30, 2020
Summary
This study introduces a novel laparoscopic approach for liver segment 7 resection, improving tumor removal safety and technical feasibility. The in situ split technique offers a minimally invasive option for hepatocellular carcinoma treatment.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Traditional liver segment 7 (S7) resection involves extensive liver mobilization and right hepatic vein (RHV) control, compromising the "no-touch" principle for malignant tumors.
- This approach presents technical challenges, particularly in laparoscopic settings, with limited reports on isolated totally laparoscopic anatomic S7 segmentectomy.
Purpose of the Study:
- To describe a novel technique for laparoscopic anatomic S7 segmentectomy using an in situ split approach.
- To evaluate the feasibility and preliminary outcomes of this technique in patients with hepatocellular carcinoma.
Main Methods:
- A retrospective study of patients undergoing laparoscopic anatomic S7 segmentectomy between September 2017 and May 2019.
- The in situ split approach utilized main vessels as landmarks for liver transection along intersectoral and intersegmental planes, avoiding extensive liver mobilization and RHV control.
Main Results:
- The study included 24 patients (9 women, 15 men) with a mean tumor diameter of 3.4 cm.
- All procedures were completed laparoscopically with no perioperative deaths, average operative time of 216.5 minutes, and average blood loss of 320 ml.
- Pathological examination confirmed R0 resections in all cases.
Conclusions:
- Laparoscopic anatomic S7 segmentectomy via the in situ split approach is technically feasible and achieves R0 resection for primary liver cancer.
- This method enhances surgical view and maneuverability, adhering better to the "no-touch" principle for malignant tumors.
- Long-term oncological outcomes warrant further investigation.
