Andrew A. Gumbs, MD; Brice Gayet, MD, PhD
Laparoscopic resection of peripheral hepatic segments has become increasingly more common in the surgical treatment of both benign and malignant tumors. The minimally invasive approach to major hepatectomies, however, is still only being currently performed in highly specialized centers. This is principally because of concerns for gas embolism and difficulty in controlling major hemorrhage via the laparoscopic approach. This video will demonstrate the relevant technical maneuvers in the performance of a totally laparoscopic right hepatectomy.
This video will illustrate the pertinent issues regarding instrument selection,trochar placement, intra-operative monitoring and steps necessary to perform right hepatectomy using totally laparoscopic techniques.
The principal steps of this procedure include: control of hepatic inflow, division of hepatic parenchyma, control of hepatic outflow, mobilization of theliver and specimen removal.
Minimally invasive techniques for left hepatic resections are feasible, and high volume centers that specialize in these procedures can have results similar to historical open series. Totally laparoscopic right hepatectomy should currently only be performed by surgeons with expertise in laparoscopy and hepatobiliary surgery, but will become more commonly performed in the future.