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Standardized Technique of Selective Left Liver Vascular Exclusion During Laparoscopic Liver Resection for Benign and Malignant Tumors

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Tumors located close to major hepatic veins pose a technical challenge to standard laparoscopic liver resection. Hepatic outflow occlusion may reduce the risks of bleeding from hepatic vein and gas embolism. The aim of this study was to detail our standardized laparoscopic approach for a safe extrahepatic control of the common trunk of middle and left hepatic veins during laparoscopic liver resection and to assess its feasibility in patients with tumors located in both right and left lobes of the liver.

Methods

Data of 25 consecutive patients who underwent laparoscopic liver resection with extrahepatic control of the common trunk of middle and left hepatic veins were reviewed.

Results

All patients underwent primary hepatectomy. The vast majority (84%) of patients had malignant tumors. The control of the common trunk of middle and left hepatic veins was achieved in 96% of patients. There were 14 (56%) major hepatectomies and 11 (44%) minor hepatectomies. Some form of vascular clamping was performed in 23 (62%) patients: Pringle maneuver in 17 (median time = 45 min; range, 10–109) and selective vascular exclusion of the liver in 6 patients (median time = 30 min; range, 15–94). The median duration of operation was 254 min (range, 70–441). There was one case (4%) of gas embolism but without any complications during the postoperative course. Conversion to open surgery was performed in 2 (7.7%) patients: 1 for oncologic reason and 1 for non-progression during the transection plane. Perioperative blood transfusion rate was nil. The overall morbidity rate was 24%.

Conclusions

The laparoscopic approach for an extrahepatic control of the common trunk of middle and left hepatic veins is reproducible, safe, and effective, and can be applied during laparoscopic liver resection for tumors close to major hepatic veins.

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Authors and Affiliations

  1. Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France

    Morgan Vandermeulen MD, Chetana Lim MD, PhD, Claire Goumard MD & Olivier Scatton MD, PhD.

  2. Division of Abdominal Surgery and Transplantation, University of Liege Hospital (CHU ULiège), Liège, Belgium

    Morgan Vandermeulen MD

  3. Sorbonne Université, Paris, France

    Claire Goumard MD & Olivier Scatton MD, PhD.

  4. Centre de Recherche de Saint-Antoine (CRSA), INSERM, UMRS-938, Paris, France

    Claire Goumard MD & Olivier Scatton MD, PhD.

Authors
  1. Morgan Vandermeulen MD
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  2. Chetana Lim MD, PhD
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  3. Claire Goumard MD
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  4. Olivier Scatton MD, PhD.
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Contributions

Study conception and design: Vandermeulen, Lim, Scatton

Acquisition of data: Vandermeulen, Lim, Goumard, Scatton

Analysis and interpretation of data: Vandermeulen, Lim, Goumard, Scatton

Drafting of manuscript: Vandermeulen, Lim, Scatton

Critical revision: Vandermeulen, Lim, Goumard, Scatton

Final approval of the article: Vandermeulen, Lim, Goumard, Scatton

Corresponding author

Correspondence to Olivier Scatton MD, PhD..

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The authors declare no competing interests.

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M.V and C. L are co-first authors.

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Vandermeulen, M., Lim, C., Goumard, C. et al. Standardized Technique of Selective Left Liver Vascular Exclusion During Laparoscopic Liver Resection for Benign and Malignant Tumors. J Gastrointest Surg 25, 2720–2725 (2021). https://doi.org/10.1007/s11605-021-05059-1

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  • DOI: https://doi.org/10.1007/s11605-021-05059-1

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