Laparoscopic liver resection for segment VII lesion using a combination of rubber band retraction method and flexible laparoscope

Modified extracorporeal traction with wires: a method for steering the liver for laparoscopic resection of hepatic tumors in segment 7 (with video)

BACKGROUND

Laparoscopic hepatectomy is a less traumatic, minimally invasive procedure that has been widely used to address liver tumors because of its association with a faster recovery and less bleeding. Although adequate exposure and transposition of the liver ensure a clear surgical field and a successful operation, tumors in S7 present a challenge in that surgeons experience difficulty in exposing such tumors and the operating space is small. We used a modified extracorporeal traction with wires method for use in minimally invasive hepatic resection surgery to improve visibility of the surgical field and therefore reduce the difficulty of surgery. The method involved adjusting the traction force appropriately for transposition of the liver.

METHODS

We reviewed data from 15 laparoscopic hepatic tumor resections performed between January and November 2024. In this paper, we describe the surgical and traction techniques used and evaluate the intraoperative and postoperative course.

RESULTS

The study population consisted of 9 males and 6 females, and the median mean age was 61.84 ± 11.08 years (Table 1). The median body mass index was 25.65 ± 3.14 kg/m2, the median tumor size was 3.78 ± 2.09 cm, the median operative time was 154.09 ± 31.97 min, the median intraoperative blood loss volume was 115.36 ± 51.26 ml, and the median hospitalization time was 10.33 ± 2.09 days.No serious intraoperative or postoperative complications occurred, and R0 resection was achieved in all cases. Morevoer, in all cases, the time to set up bandwire extracorporeal traction was less than 3 min.

CONCLUSION

The bandwire traction technique can provide a more stable surgical field, shorten the surgical time, and reduce the likelihood of surgical trauma. The technique allows safe transposition of the liver and plays an important role in minimally invasive resection of hepatic tumors, highlighting its suitability for widespread clinical applications.

Robotic anatomical resection for hepatocellular carcinoma located within segment 7 using the Glissonean approach

Worldwide use of robotic-assisted hepatectomy has increased dramatically over the past two decades. The role of robotic liver surgery is still controversial, especially with respect to its long-term oncological outcomes in treating early-stage hepatocellular carcinoma (HCC). The Glissonean approach is a fundamental technique for anatomical resection using open and laparoscopic liver surgery. To our knowledge, there have been few reports on purely robotic anatomical segmentectomy 7 for HCC using the Glissonean approach have been described. The present study describes the technical details and surgical outcomes of totally robotic segmentectomy 7 using the Glissonean approach. Fourteen patients with HCC limited to segment 7 underwent segmentectomy 7 from January 2019 through April 2023 in our hospital. The surgical techniques, peri-operative, and oncological outcomes were analyzed. Purely robotic anatomical segmentectomy 7 using the Glissonean approach was safe and feasible with the technology described herein in all of the 14 patients. The peri-operative and oncological outcomes were better and/or comparable with those of other similar hepatic resections using open approach and/or laparoscopic approach. The median follow-up time was 18 months. Intrahepatic recurrence occurred in 2 (14.3%) patient within one year following surgery. The 3-year overall survival rate was 81%. Although technically challenging, the purely robotic segmentectomy 7 could be performed safely and simultaneously with oncological radicality using the Glissonean approach.

Robotic Anatomical Liver Resection for Segment 7 Lesions Utilizing Saline-Linked Cautery (SLiC) Method

Introduction Anatomical hepatectomy for segment 7 (S7) lesions is technically challenging due to their restricted accessibility and close proximity to the right hepatic vein, and the robotic approach for this challenging situation is currently not supported by conclusive data. Methods We present our novel technique of robotic anatomical hepatectomy for S7 lesions utilizing the saline-linked cautery (SLiC) method. Between 2022 and 2023, 10 robotic S7 subsectionectomy or right posterior sectionectomy were performed and included in the current study. The historical control group included patients undergoing laparoscopic anatomical hepatectomy for S7 lesions between 2017 and 2021 (n=9). Surgical outcomes were compared between the groups to assess the efficacy and safety of our technical robotic approach for S7 lesions. Results There were no conversions to open liver resection, no cases of grade B or C post-hepatectomy liver failure, and no mortality in the whole cohort. Although no difference was found between the laparoscopic and robotic groups in the difficulty score, operative time, and rate of red blood cell transfusion, the robotic group had a significantly lesser amount of surgical blood loss (28mL vs. 280mL, p=0.005). Concerning postoperative complications, one patient had liver subcapsular hematoma in the robotic group, although neither bile leakage nor intraperitoneal abscess occurred in the whole cohort. Conclusions Although robotic right posterior sectionectomy and S7 subsectionectomy of the liver are technically demanding procedures, the intrahepatic Glissonean approach using the SLiC method is safe and feasible. It might be performed without increasing the incidence of postoperative complications. Thus, the current approach can be considered as one of the preferred options for robotic anatomical hepatectomy for S7 lesions.

Intrahepatic Glissonean Approach for Robotic Anatomical Liver Resection of Segment 7 Using the Saline-Linked Monopolar Cautery Scissors (SLiC-Scissors) Method: A Technical Case Report With Videos

Anatomical hepatectomy of segment 7 (S7) is technically difficult due to its difficult accessibility. Here, we present our experience of robotic anatomical S7 subsectionectomy of the liver employing the saline-linked cautery scissors (SLiC-Scissors) technique. After the right lobe was fully mobilized, dissection of the Glissonean pedicle and hepatic venous branch of S7, as well as the liver parenchymal transection, were safely performed using the SLiC-Scissors method. Despite its technological complexity, the intrahepatic Glissonean approach for robotic anatomical S7 subsectionectomy of the liver employing the SLiC scissors method is safe and efficient.

Laparoscopic Minor Liver Resections for Hepatocellular Carcinoma in the Posterosuperior Segments Using the Rubber Band Technique

BACKGROUND

Although laparoscopic minor liver resections (LLR) of posterosuperior (PS) segments are technically challenging, several expert centers are increasingly performing this procedure. In the present study, we introduced novel techniques, including the rubber band traction method and positional changes, and compared surgical outcomes of LLR for hepatocellular carcinoma (HCC) located in PS segments with open minor liver resection (OLR).

METHODS

From January 2008 to August 2019, 113 patients underwent laparoscopic (n = 55) or open (n = 58) minor liver resections for single small HCCs (<5 cm) located in PS segments. Propensity score matching in a 1:1 ratio was conducted to minimize preoperative selection bias, and surgical outcomes were compared between the two groups.

RESULTS

There was no intraoperative mortality or reoperation in either group. One conversion to open surgery was necessary due to severe post-operative adhesions. The matched LLR group compared to OLR had significantly shorter operative time (215.16 vs. 251.41 min, P = 0.025), lesser blood loss (218.11 vs. 358.92 mL, P = 0.046), lower complication rate (8.1% vs. 29.7%, P = 0.018), and shorter hospital stay (7.03 vs. 11.78 days, P = 0.001). Intraoperative transfusion, R0 resection, resection margin, 5-year disease-free survival and 5-year overall survival were comparable.

CONCLUSION

Our standardized LLR provided improved short-term outcomes and similar long-term outcomes, when compared with OLR. With advanced techniques and accumulated surgical experience, LLR can be the first option for HCC in PS segments at expert centers.

Laparoscopic liver resection of segment seven: A case report and review of surgical techniques

INTRODUCTION

Laparoscopic liver resection of segment seven (LLR-S7) is a technically challenging procedure due to its anatomical location and difficult accessibility. Herein, we present our experience with LLR-S7, and demonstrate a literature review regarding surgical techniques.

PRESENTATION OF CASE

A 28-year-old female was diagnosed with rectosigmoid cancer and synchronous liver metastases at the segment three (S3) and S7, which were treated with laparoscopic procedure. After the completely mobilization of the right lobe, the Glissonean pedicle of S7 (G7) was intrahepatically transected. The right hepatic vein was exposed to identify the venous branch of S7 (V7). Finally the liver parenchyma between RHV and dissection line was divided.

DISCUSSION

Various laparoscopic approaches for S7 have been reported including the Glissonian approach from the hilum, the intrahepatic Glissonean approach, the caudate lobe first approach, and the lateral approach from intercostal ports. To perform LLR-S7 safely, it is important to understand the advantage of each technique including the trocar placement and approaches to S7 by laparoscopy.

CONCLUSION

We present our experience of LLR-S7 for the tumor located at the top of S7, successfully performed with the intrahepatic Glissonean approach. LLR-S7 can be performed safely with advanced laparoscopic techniques and sufficient knowledge on various approaches for S7.