Laparoscopic Approach to Left Hepatectomy Using a StandardizedTechnique

Abstract

Introduction: The laparoscopic approach in liver surgery has been preferred over the traditional approach in the resection of segments 2 and 3, as laparoscopic surgical technique can be standardized for easy adoption and is minimally invasive. This paper describes the laparoscopic surgical technique and recommends the patient selection criteria in the resection of segments 2, 3 and 4.
Methods: This technique involves 2 key steps – early division of the left pedicle before the division of the liver parenchyma and the placement of an instrument beneath the transection plane to simulate a ‘hanging manoeuvre’ with reduced blood loss and allows the expeditious division of the liver parenchyma. Apart from the usual contraindications to liver resections, specific contraindications to this technique include patients with aberrant biliary drainage of right liver segments into the left hepatic duct, patients with tumours abutting the hilar plate and patients with tumours located near the junction of the left hepatic vein and the vena cava.
Conclusion: The authors recommend these steps to serve as a standardized technique for laparoscopic hepatectomy of segments 2,3 and 4 in selected patients, allowing the learning curve for this technique to be markedly shortened.