Comparison of resection site of standardized laparoscopic hepatic tumor resection

Abstract

Introduction: The degree of difficulty in laparoscopic hepatic resection (LHR) was higher in tumors involving the suprahepatic segments than other sites. However, thanks to surgical instruments and procedures being improved and standardized, LHR can be performed safely in all regions. Aim: We report our standardized surgical techniques and outcomes in a series of patients undergoing LHR in our hospital and analyze the surgical outcomes, particularly with regard to the site of resection. Material and methods: We retrospectively analyzed data from 238 patients who underwent standardized laparoscopic partial hepatic resection between 2010 and 2017. In standardized LHR, the operator formed a triangle with the laparoscope in the center, maintaining a co-axial position by changing the port where the laparoscope was inserted. Results: Operative time for the resection of tumors of the right hepatic lobe was 202 ±92 min and 140 ±104 min for tumors of the left hepatic lobe (p = 0.0024); intraoperative blood loss was 80 ±170 ml and 19 ±127 ml, respectively (p = 0.0016). No differences were found in the surgical outcomes between the various segments of the right hepatic lobe. In the left hepatic lobe, operative time was significantly shorter with laparoscopic tumor resection in segment III (p = 0.0023). Conclusions: During standardized LHR, a better field of vision with the greater ease can be established during resection of the left hepatic lobe compared to that of the right hepatic lobe. Nonetheless, LHR of the right lobe can be performed safely using various surgical instruments and techniques.