Laparoscopic liver resection in the semiprone position for tumors in the anterosuperior and posterior segments, using a novel dual-handling technique and bipolar irrigation system

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• 作者：Tetsuo Ikeda (1)
  Takao Toshima (1)
  Norifumi Harimoto (1)
  Youichi Yamashita (1)
  Toru Ikegami (1)
  Tomoharu Yoshizumi (1)
  Yuji Soejima (1)
  Ken Shirabe (1)
  Yoshihiko Maehara (1)
  
• 关键词：Pure laparoscopic hepatectomy ; Semiprone position ; Anterosuperior and posterior segments ; Dual ; handling technique ; Intercostal transthoracic port
• 刊名：Surgical Endoscopy
• 出版年：2014
• 出版时间：August 2014
• 年：2014
• 卷：28
• 期：8
• 页码：2484-2492
• 全文大小：4,017 KB
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• 作者单位：Tetsuo Ikeda (1)
  Takao Toshima (1)
  Norifumi Harimoto (1)
  Youichi Yamashita (1)
  Toru Ikegami (1)
  Tomoharu Yoshizumi (1)
  Yuji Soejima (1)
  Ken Shirabe (1)
  Yoshihiko Maehara (1)
  
  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
  
• ISSN：1432-2218

文摘

Background Hepatic tumors in the lower edge and lateral segments are commonly treated by laparoscopic liver resection. Tumors in the anterosuperior and posterior segments are often large and locally invasive, and resection is associated with a higher risk of insufficient surgical margins, massive intraoperative bleeding, and breaching of the tumor. Laparoscopic surgery for such tumors often involves major hepatectomy, including resection of a large volume of normal liver tissue. We developed a novel method of laparoscopic resection of tumors in these segments with the patient in the semiprone position, using a dual-handling technique with an intercostal transthoracic port. The aim of this study was to evaluate the safety and usefulness of our technique. Methods Of 160 patients who underwent laparoscopic liver resection at our center from June 2008 to May 2013, we retrospectively reviewed those with tumors in the anterosuperior and posterior segments. Patients were placed supine or semilateral during surgery until January 2010 and semiprone from February 2010. Results Before the introduction of the semiprone position in February 2010, a total of 7 of 40 patients (17.5?%) with tumors in the anterosuperior and posterior segments underwent laparoscopic liver resection, and after introduction of the semiprone position, 69 of 120 patients (57.5?%) with tumors in the anterosuperior and posterior segments underwent laparoscopic liver resection (P?P? Conclusions Laparoscopic liver resection in the semiprone position is safe and increases the number of patients who can be treated by laparoscopic surgery without increasing the frequency of major hepatectomy.