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Laparoscopic Segmentectomy of the Liver: From Segment I to VIII

Ishizawa, Takeaki MD, PhD*,†; Gumbs, Andrew A. MD; Kokudo, Norihiro MD, PhD; Gayet, Brice MD, PhD*

doi: 10.1097/SLA.0b013e31825ffed3
Surgical Technique

Objective: To evaluate the surgical techniques necessary to complete total laparoscopic segmentectomy (LS) of all liver segments (I–VIII).

Background: When compared to open surgery, preservation of functional hepatic volume may be more difficult during laparoscopic hepatectomy. LS is a possible alternative to hemihepatectomy, but laparoscopic surgical techniques to complete anatomically accurate segmentectomy have not yet been well established.

Methods: Data of a total of 342 consecutive patients who underwent laparoscopic hepatectomy were reviewed. LS was defined as complete removal of the Couinaud's segment, in which the corresponding hepatic veins are exposed on the raw surface. The laparoscopic approach was facilitated by using intraoperative ultrasonography for each segment and by placing intercostal trocars to expose the root of the right hepatic vein for segmentectomy VII and VIII.

Results: LS was completed in 62 patients: 36 segmentectomies (from I–VIII), 16 bisegmentectomies of the right lobe, and 10 subsegmentectomies were performed. Conversion to open surgery was required in 3 patients (IVa, VI, and VII). When 26 LS of the superior/posterior hepatic (sub)segments (I, IVa, VII, and VIII) were compared with the remaining 36 LS, the former group required a longer operation time (240 [132–390] minutes vs 155 [90–360]) minutes, P < 0.01) and showed an increased amount of blood loss (350 [20–1500] mL vs 100 [10–1100] mL, P = 0.02).

Conclusions: LS is feasible and has become an essential surgical technique that can minimize the loss of functional liver volume without reducing curability, although further technical advancements are needed to enhance the accuracy of the resection, especially for the superior/posterior segments.

Supplemental Digital Content is Available in the Text.Surgical techniques necessary to complete laparoscopic anatomic segmentectomy have been described. These techniques are feasible and essential for minimizing the loss of functional liver volume without reducing curability, although further technical advancements are needed to enhance the accuracy of the resection, especially for the superior/posterior (sub)segments (I, IVa, VII, and VIII).

*Department of Digestive Diseases, Institut Mutualiste Montsouris, University Paris V, France

Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan

Department of Surgical Oncology, Summit Medical Group, Berkeley Heights, NJ.

Reprints: Brice Gayet, MD, PhD, Department of Digestive Diseases, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France. E-mail: brice.gayet@imm.fr

Disclosure: This work was supported by grants from the Takeda Science Foundation, the Kanae Foundation for the Promotion of Medical Science, the Pancreas Research Foundation of Japan, the Canon Foundation in Europe, and the Ministry of Education, Culture, Sports, Science and Technology of Japan (No. 23689060).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsofsurgery.com).

© 2012 Lippincott Williams & Wilkins, Inc.