Studies On The Minimally Invasive Surgical Technique Of Laparoscopic Hepatectomy

Objective: By studying the basis and technique of laparoscopic hepatectomy (LH), especially LH for primary liver cancer, to evaluate the feasibility, validity and practicability of minimally invasive surgical technique of LH.Methods: The author designed a manoeuvre for laparoscopic hepatic resection, which is 'To obstruct the hepatic blood current at the first grade porta, to amputate the porta hepatic vessels at the second grade porta'. From July 2002 to March 2004, 47 patients with solid liverneoplasm were included in this study. In patients with solid tumors or local focus, located in the left lateral segments or in the anterior segments of the right liver were candidates. Male in 35 cases and female in 12 cases. The age lay between 27 and 67 yrs, it was 46.2\9.6 yrs in average. Candidates included 25 cases of primary liver cancer, 9 cases of liver hamangioma, 10 cases of other benign liver neoplasm , 2 case of infected liver cyst and one case of introhepatic calculi. HBsAg (+) in 15 cases, Anti-HCV(+) in 3 cases, liver cirrhosis in 22 cases, Child A in 40 cases and B in 7 cases. AFP(+) in 9 cases. The mean tumor size was 5.4\2.8cm in diameter. Laparoscopic manoeuvres included mobilization of the liver, dissection of grade 2 and 3 porta hepatic vessels, dissection of left hepatic vein and liver transection. Hemihepatectomy was undertaken at the exclusion of hepatopetal blood flow. The principle of tumor treatment were carried out accordingly.Results: The total laparoscopic hepatic resections were successful in 43 of 47 patients. Liver procedures included 27 partial or segment resections and 16 cases anatomical liver resections, which including left hemihepatectomy in 5 cases, right segment hepatectomy in 3 cases, leftlateral hepatectomy in 7 cases and quadrate lobectomy in one. The operation time averaged at 182.3\67.2 min. The average intra-operative blood loss was 411.4\402.6 ml.The average postoperative hospital stay was 5.5\1.4 days. No complication occurred. Postoperative one year survival rate for primary liver cancer is 100% and recurrence rate is only 15.4^(2/13).Conclusions: laparoscopic hepatic resections are technically feasible with laparoscopic expertise in anatomical dissection and transection of sub-grade porta hepatic vessels. The author designed manoeuvre for laparoscopic hepatic resection is feasible and practicable. Laparoscopic liver resection for malignant liver tumors is feasible and safe. Laparoscopic hepatectomy can be a new alternative for patients with tumors located in the left liver or in the anterior segments of the right liver. The short-term outcome is satisfactory and the long-term prognosis needs to be evaluated further.