Hand-Assisted Laparoscopic Hepatectomy for Solid Tumor in the Posterior Portion of the Right Lobe

Initial Experience

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

Objective: To prove the feasibility of hand-assisted laparoscopic liver resection for tumors located in the posterior portion of the right hepatic lobe. Summary Background Data: Use of laparoscopic liver resection remains limited due to problems with technique, especially when the tumor is located near the diaphragm, or in the posterior portion of the right lobe. Methods: Between October 2001 and June 2002, a total of 7 patients with solid hepatic tumors involving the posterior portion of the right lobe of liver underwent hand-assisted laparoscopic hepatectomy with the HandPort system at our hospital. Surgical techniques used included CO2 pneumoperitoneum and the creation of a wound on the right upper quadrant of the abdomen for HandPort placement. The location of tumor and its transection margin were decided by laparoscopic ultrasound. The liver resection was performed using the Ultrashear without portal triad control, with the specimens obtained then placed in a bag and removed directly via the HandPort access. Results: The 5 male and 2 female patients ranged in age from 41 to 76 years (mean 62.3 ± 14.4). Surgical procedures included partial hepatectomy for 6 patients and segmentectomy for one, all successfully completed using a variant of the minimally invasive laparoscopic procedure without conversion to open surgery. The mean duration of the operation was 140.7 ± 42.2 minutes (90-180). The blood loss during surgery was 257.1 ± 159 mL (250-500), without any requirement for intraoperative or postoperative transfusion. Pathology revealed hemagioma (n = 2), colon cancer metastasis (n = 2), and hepatocellular carcinoma (n = 3). There were no deaths postoperatively, with 1 patient suffering bile leakage. Mean hospital stay was 5.3 ± 1.3 days postsurgery. Conclusion: The results of this study suggest that laparoscopic liver resection using the HandPort system is feasible for selected patients with lesions in the posterior portion of the right hepatic lobe requiring limited resection. Individuals with small tumors may benefit; because a large abdominal incision is not required, the wound-related complication rate might be reduced.

Original languageEnglish
Pages (from-to)674-679
Number of pages6
JournalAnnals of Surgery
Volume238
Issue number5
DOIs
Publication statusPublished - Nov 2003
Externally publishedYes

Fingerprint

Hepatectomy
Hand
Liver
Neoplasms
Conversion to Open Surgery
Pneumoperitoneum
Segmental Mastectomy
Wounds and Injuries
Diaphragm
Bile
Abdomen
Colonic Neoplasms
Hepatocellular Carcinoma
Length of Stay
Pathology
Neoplasm Metastasis

ASJC Scopus subject areas

  • Surgery

Cite this

@article{659bb60308e74e15a4489a985524383c,
title = "Hand-Assisted Laparoscopic Hepatectomy for Solid Tumor in the Posterior Portion of the Right Lobe: Initial Experience",
abstract = "Objective: To prove the feasibility of hand-assisted laparoscopic liver resection for tumors located in the posterior portion of the right hepatic lobe. Summary Background Data: Use of laparoscopic liver resection remains limited due to problems with technique, especially when the tumor is located near the diaphragm, or in the posterior portion of the right lobe. Methods: Between October 2001 and June 2002, a total of 7 patients with solid hepatic tumors involving the posterior portion of the right lobe of liver underwent hand-assisted laparoscopic hepatectomy with the HandPort system at our hospital. Surgical techniques used included CO2 pneumoperitoneum and the creation of a wound on the right upper quadrant of the abdomen for HandPort placement. The location of tumor and its transection margin were decided by laparoscopic ultrasound. The liver resection was performed using the Ultrashear without portal triad control, with the specimens obtained then placed in a bag and removed directly via the HandPort access. Results: The 5 male and 2 female patients ranged in age from 41 to 76 years (mean 62.3 ± 14.4). Surgical procedures included partial hepatectomy for 6 patients and segmentectomy for one, all successfully completed using a variant of the minimally invasive laparoscopic procedure without conversion to open surgery. The mean duration of the operation was 140.7 ± 42.2 minutes (90-180). The blood loss during surgery was 257.1 ± 159 mL (250-500), without any requirement for intraoperative or postoperative transfusion. Pathology revealed hemagioma (n = 2), colon cancer metastasis (n = 2), and hepatocellular carcinoma (n = 3). There were no deaths postoperatively, with 1 patient suffering bile leakage. Mean hospital stay was 5.3 ± 1.3 days postsurgery. Conclusion: The results of this study suggest that laparoscopic liver resection using the HandPort system is feasible for selected patients with lesions in the posterior portion of the right hepatic lobe requiring limited resection. Individuals with small tumors may benefit; because a large abdominal incision is not required, the wound-related complication rate might be reduced.",
author = "Huang, {Ming Te} and Lee, {Wei Jei} and Weu Wang and Wei, {Po Li} and Chen, {Robert J.}",
year = "2003",
month = "11",
doi = "10.1097/01.sla.0000094301.21038.8d",
language = "English",
volume = "238",
pages = "674--679",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Hand-Assisted Laparoscopic Hepatectomy for Solid Tumor in the Posterior Portion of the Right Lobe

T2 - Initial Experience

AU - Huang, Ming Te

AU - Lee, Wei Jei

AU - Wang, Weu

AU - Wei, Po Li

AU - Chen, Robert J.

PY - 2003/11

Y1 - 2003/11

N2 - Objective: To prove the feasibility of hand-assisted laparoscopic liver resection for tumors located in the posterior portion of the right hepatic lobe. Summary Background Data: Use of laparoscopic liver resection remains limited due to problems with technique, especially when the tumor is located near the diaphragm, or in the posterior portion of the right lobe. Methods: Between October 2001 and June 2002, a total of 7 patients with solid hepatic tumors involving the posterior portion of the right lobe of liver underwent hand-assisted laparoscopic hepatectomy with the HandPort system at our hospital. Surgical techniques used included CO2 pneumoperitoneum and the creation of a wound on the right upper quadrant of the abdomen for HandPort placement. The location of tumor and its transection margin were decided by laparoscopic ultrasound. The liver resection was performed using the Ultrashear without portal triad control, with the specimens obtained then placed in a bag and removed directly via the HandPort access. Results: The 5 male and 2 female patients ranged in age from 41 to 76 years (mean 62.3 ± 14.4). Surgical procedures included partial hepatectomy for 6 patients and segmentectomy for one, all successfully completed using a variant of the minimally invasive laparoscopic procedure without conversion to open surgery. The mean duration of the operation was 140.7 ± 42.2 minutes (90-180). The blood loss during surgery was 257.1 ± 159 mL (250-500), without any requirement for intraoperative or postoperative transfusion. Pathology revealed hemagioma (n = 2), colon cancer metastasis (n = 2), and hepatocellular carcinoma (n = 3). There were no deaths postoperatively, with 1 patient suffering bile leakage. Mean hospital stay was 5.3 ± 1.3 days postsurgery. Conclusion: The results of this study suggest that laparoscopic liver resection using the HandPort system is feasible for selected patients with lesions in the posterior portion of the right hepatic lobe requiring limited resection. Individuals with small tumors may benefit; because a large abdominal incision is not required, the wound-related complication rate might be reduced.

AB - Objective: To prove the feasibility of hand-assisted laparoscopic liver resection for tumors located in the posterior portion of the right hepatic lobe. Summary Background Data: Use of laparoscopic liver resection remains limited due to problems with technique, especially when the tumor is located near the diaphragm, or in the posterior portion of the right lobe. Methods: Between October 2001 and June 2002, a total of 7 patients with solid hepatic tumors involving the posterior portion of the right lobe of liver underwent hand-assisted laparoscopic hepatectomy with the HandPort system at our hospital. Surgical techniques used included CO2 pneumoperitoneum and the creation of a wound on the right upper quadrant of the abdomen for HandPort placement. The location of tumor and its transection margin were decided by laparoscopic ultrasound. The liver resection was performed using the Ultrashear without portal triad control, with the specimens obtained then placed in a bag and removed directly via the HandPort access. Results: The 5 male and 2 female patients ranged in age from 41 to 76 years (mean 62.3 ± 14.4). Surgical procedures included partial hepatectomy for 6 patients and segmentectomy for one, all successfully completed using a variant of the minimally invasive laparoscopic procedure without conversion to open surgery. The mean duration of the operation was 140.7 ± 42.2 minutes (90-180). The blood loss during surgery was 257.1 ± 159 mL (250-500), without any requirement for intraoperative or postoperative transfusion. Pathology revealed hemagioma (n = 2), colon cancer metastasis (n = 2), and hepatocellular carcinoma (n = 3). There were no deaths postoperatively, with 1 patient suffering bile leakage. Mean hospital stay was 5.3 ± 1.3 days postsurgery. Conclusion: The results of this study suggest that laparoscopic liver resection using the HandPort system is feasible for selected patients with lesions in the posterior portion of the right hepatic lobe requiring limited resection. Individuals with small tumors may benefit; because a large abdominal incision is not required, the wound-related complication rate might be reduced.

UR - http://www.scopus.com/inward/record.url?scp=0642307708&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0642307708&partnerID=8YFLogxK

U2 - 10.1097/01.sla.0000094301.21038.8d

DO - 10.1097/01.sla.0000094301.21038.8d

M3 - Article

VL - 238

SP - 674

EP - 679

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 5

ER -