• Medicine · Mar 2024

    Dorsal approach in laparoscopic extended left hemi-hepatectomy: A case series.

    • Katsunori Sakamoto, Kohei Ogawa, Kei Tamura, Masahiko Honjo, Takahiro Hikida, Chihiro Ito, Miku Iwata, Akimasa Sakamoto, Mikiya Shine, Yusuke Nishi, Mio Uraoka, Tomoyuki Nagaoka, Naotake Funamizu, and Yasutsugu Takada.
    • Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan.
    • Medicine (Baltimore). 2024 Mar 1; 103 (9): e37336e37336.

    RationaleThe utility of the dorsal approach has been reported for laparoscopic left hemi-hepatectomy.Patient ConcernsThe aim of the present study is to show the usefulness of the dorsal approach for laparoscopic extended left-hemi-hepatectomy while ensuring safe identification of hepatic veins and dissection of the dorsal tumor margin.DiagnosesTumors requiring extended left hemi-hepatectomy.InterventionsAfter mobilization of the lateral sector and division of the Arantius plate, parenchyma above the Arantius plate is removed to expose the root of the middle hepatic vein and left hepatic vein. Each of these veins can be isolated separately either intra- or extra-hepatically. After removing the parenchyma on the cranial side of the left Glissonean pedicle continuous with the exposed hepatic veins, the left Glissonean pedicle is isolated using the Glissonean pedicle transection method. After division of the left hepatic vein and Glissonean pedicle, segment 4 (in which the main part of the tumor is commonly located) is dissected from the anterior plane of the paracaval portion of the caudate lobe by the dorsal approach, along with the hepatic hilum. Following dissection of the dorsal side of the tumor, and division of parenchyma from the anterior edge of the liver, the anterior Glissonean branches and middle hepatic vein are divided safely and the specimen is resected.OutcomesThree patients underwent laparoscopic extended left hemi-hepatectomy, with no open conversions. Operative time and blood loss were 331 (concomitant with another partial hepatectomy), 277, and 315 minutes; and 200, 100, and 100 g, respectively. The postoperative courses were uneventful.LessonsThe dorsal approach maximizes the advantages of laparoscopic extended left hemi-hepatectomy and can be performed safely.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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