演題

IS-3-6

A single center experience of Laparoscopic liver resections with a central focus on the right posterior sectionectomy.

[演者] 海津 貴史:1
[著者] 隈元 雄介:1, 久保 任史:1, 田島 弘:1, 西山 亮:1, 渡邊 昌彦:1
1:北里大学外科

INTRODUCTION: Although the improvement of the technical quality in laparoscopic liver resection (LLR) expanded the indication of LLR to anatomical liver resections including major hepatectomy, the right posterior sectionectomy (rPS) has still been challenging. In this study, we report our institutional experience of LLR and show our procedure of LLR with a central focus on the rPS.METHODS: Between August 2002 and August 2014, 142 LLRs were performed and included in this retrospective study. Among the 142 LLRs, 108 cases were carried out after April 2012.RESULTS: Ten patients had benign tumor and 132 had malignant tumors including HCC in 74 patients and colorectal metastasis in 52. LLRs were performed with a totally laparoscopic approach (Pure: 73%), hand-assisted approach (HALS: 17%) or laparoscopic-assisted open hybrid technique (Hybrid: 10%). The resections included 81 (57%) partial resections, 31 (22%) anatomical left lateral sectionectomies, 7 (5%) left hemihepatectomies, 9 (6%) right hemihepatectomies and 14 (10%) rPS. Median operative time, intraoperative blood loss and postoperative hospital stay were 417.0 min, 469.7 ml and 10.6 day, respectively. In case of rPS, pure-lap showed better surgical outcome as compared with Hybrid or HALS (see figure).CONCLUSIONS: During liver transection for rPS, HALS prefer anterior approach to caudal approach, however, Pure-lap enable us to choose both approaches, may contribute to improvement of surgical outcome in Pure-lap technique. We show the video of pure-lap rPS.
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