C.G.S. Huscher MD, FACS, FRCS; M. Di Paola MD; C. Ponzano MD; A. Recher MD; G. Sgarzini MD; A. Mingoli MD, FACS
The role of laparoscopy in liver surgery is still a subject of debate. Up to now, isolated hepatic lesions requiring a segmental (or bisegmental) resection have been considered to be an indication for laparoscopic surgery only when they are located in the left lobe or in the right lower lobe. Use of laparoscopic liver resection remains limited due to problems with technique, especially when the tumor is located near the diaphragm, or in the posterior portion of the right lobe. Here we report a case of a laparoscopic resection performed for a colorectal carcinoma metastatic on segment eight.
Four trocars were used. The location of tumor and its transection margin were decided by laparoscopic ultrasound and confirmed by methylene blue injections into the paramedian hepatic artery. The liver was transected with Ultrasound Scalpel, CUSA and bipolar forceps. Operation time was 180 min and postoperative oral intake occurred on day 1. No complication was observed during the perioperative period. Laparoscopic treatment of lesion in segment eight is feasible in selected patients. It is technically demanding but can be safely accomplished by surgeons who have experience in advanced laparoscopic procedures and open hepatic surgery.