Laparoscopic Central Bisectionectomy and Right Anterior Sectionectomy Using Two Retraction Methods: Technical Aspects with Video

Abstract

Background: Laparoscopic central bisectionectomy and right anterior sectionectomy for centrally located tumors are technically demanding surgeries. Here, we introduce our laparoscopic technique and present the associated perioperative outcomes relative to an open approach. Methods: From April 2014 to November 2017, 26 patients underwent central bisectionectomy or right anterior sectionectomy. A total of 17 patients underwent the laparoscopic approach and nine underwent an open approach. We used a perihilar Glissonian approach to determine each anatomical resection plane and employed a rubber band self-retraction technique to ensure proper exposure of the two resection planes. Detailed descriptions, illustrations, video, and perioperative outcomes of the approach are presented. Results: Among patients who underwent the laparoscopic approach, there were no cases of conversion to open surgery. The mean operative times for the laparoscopic and open groups were similar (333 ± 76 vs. 305 ± 62 min, respectively, p = 0.345). Intraoperative blood loss (535 ± 443 vs. 966 ± 650, p = 0.056) and postoperative complications (1 vs. 3, p = 0.065) were slightly less in the laparoscopic group, but the difference was not statistically significant. Surgical margins of both approaches were comparable (0.8 ± 0.6 vs. 0.7 ± 0.2 cm, p = 0.671). The length of hospital stay after surgery was significantly shorter in the laparoscopic group (8.8 ± 2.6 vs. 17.1 ± 12.7 days, p = 0.015). Conclusion: The laparoscopic approach for central bisectionectomy and right anterior sectionectomy described in this study is feasible and safe with respect to short-term perioperative outcomes and may provide several benefits commonly attributed to minimally invasive surgery in selected patients.