Laparoscopic Hepatectomy for the Patients with Hepatocellular Carcinoma

Hironori Kaneko, Sumito Takagi, Yuuichirou Ohtsuka, Masaaki Yoshino, Naoki Joubara, Masaru Tsuchiya, Akira Tamura, Takashi Ishii and Tadaaki Shiba

2nd Department of Surgery, Toho University School of Medicine

Eight laparoscopic hepatectomies were performed in patients with hepatocellular carcinoma. Surgical procedure: A microwave tissue coagulator was used in combination with an ultrasonic surgical aspirator or laparoscopic coagulating shears to divide hepatic parenchyma by using the abdominal wall lift without pneumoperitoneum to avoid the risk of CO₂ embolism. Branched vessels and ducts were clipped and transected. An endoscopic linear stapler was used to transect the Glisson's pedicle and left hepatic vein. Hemostasis of the transection plane was secured by using an argon beam coagulator and fibrin starch. The indication for hepatectomy was hepatocellular carcinoma in 9 cases (Clinical Stage I: 5 cases, II: 3 cases, III: 1 case). Seven patients underwent partial hepatectomy and 2 patients underwent left lateral segmentectomy. The 8 hepatectomies were performed safely with no operative complication. There were notable differences in operation time and blood loss compared with open hepatectomy. The postoperative recovery was faster and pain was minimal. The preoperative assessment of liver function for laparoscopic and open hepatectomy is the same. Important considerations for the indication of laparoscopic hepatectomy are the size, type, and location of the tumor. Tumors smaller than 5 cm, and nodular types, especially extrahepatic growth types. are the best candidates for laparoscopic resection. Concerning location, tumors in the lower segment and left lateral segment were good indications. Laparoscopic hepatectomy in a patient with hepatocellular carcinoma appears to be a viable surgical alternative in selected cases.

Key words
laparoscopic hepatectomy, hepatocellular carcinoma, hepatectomy

Reprint requests
Hironori Kaneko 2nd Department of Surgery, Toho University School of Medicin 6-11-1 Omorinishi, Otaku, Tokyo, 143-0051 JAPAN

Accepted
November 30, 1999

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