The Importance of Segment 4 Anatomy on Outcomes Following Living Donor Left Lateral Segmentectomy.

BACKGROUND: During left lateral section (LLS) resection for live liver donation, the vascular inflow and the bile drainage of segment 4 (S4) are compromised. We investigated the long-term changes of S4 after donation and their potential prognostic impact on living liver donors. MATERIALS AND METHODS: This was a retrospective analysis of 42 consecutive left lateral (LLS, S2/3) liver resections for living donation. RESULTS: There were 25 female and 17 male donors. Median age was 33 y and median body mass index was 26. Median LLS, S2/3, volume was 262 cc, and median sS4 volume was 160 cc. Complications were encountered in three donors (7%). An independent extrahepatic S4 artery (S4A) (with a proximal left heptic artery or a right hepatic artery origin) was identified in 41% of the donors. Ligation of the independent S4A was not associated with the rate of post resection liver dysfunction, complications, or the degree of S4 atrophy. Having a dominant S4 portal triad pedicle feeding the right anterior sectors, segment 5/8, of the liver was associated with increased parenchymal damage as evidenced by a higher peak of alanine aminotransferase but was not associated with postoperative complications. The median degree of atrophy of S4 at 1 y post donation as noted on imaging was 66%. The presence of a dominant S4 portal triad pedicle and the peak alanine aminotransferase early postoperatively were both predictors of the degree of S4 atrophy post donation. CONCLUSIONS: The presence of an independent S4A or dominant S4 portal triad pedicle feeding the liver right anterior sectors, segment 5/8, should not be a contraindication for left lateral segment living donation.

Laparoscopic Liver Resection for Tumors in the Left Lateral Liver Section.

BACKGROUND: The laparoscopic approach is increasingly adopted for liver resections today especially for lesions located in the left lateral liver section. This study was conducted to determine the impact of the introduction of laparoscopic liver resection (LLR) as a surgical option for suspected small- to medium-sized (<8 cm) tumors located in the left lateral section (LLS). METHODS: This is a retrospective review of 156 consecutive patients who underwent LLR or open liver resection (OLR) of tumors located in the LLS. The study was divided into 2 consecutive periods (period 1, January 2003 through September 2006, and period 2, October 2006 through April 2014); LLR was available as a surgical option only in the latter period. Comparisons made were LLR versus OLR, LLR versus OLR (in period 2 only), and resections performed in period 1 versus period 2. RESULTS: Forty-two patients underwent LLR with 4 conversions. LLR was significantly associated with a longer median operative time [167.5 minutes (range, 60-525) vs 105 minutes (range, 40-235); P < .001], decreased need for the Pringle maneuver [n = 1 (2%) vs 22 (19%); P = .008], and shorter postoperative stay [n = 4 (range, 1-10) days vs 5 days (range, 2-47); P < .001] compared with open resection. Comparison of the 42 patients who underwent LLR with the 64 contemporaneous patients who underwent OLR demonstrated similar outcomes. Again, LLR was associated with a significantly longer operation, decreased need for the Pringle maneuver, and shorter hospital stay. CONCLUSIONS: LLR can be safely adopted to treat lesions in the LLS. The procedure is associated with a shorter postoperative stay and a decreased need for the Pringle maneuver, but longer operative time compared with that required for OLR.

Comparison of laparoscopic versus open left lateral segmentectomy.

BACKGROUND: Although there are data in the literature about the safety and efficacy of laparoscopic liver resections, there are not many studies comparing laparoscopic versus open approaches in a case-matched design. This study was designed to compare perioperative outcomes of the left lateral segmentectomy via laparoscopic and open approach. METHODS: From January 2009 to January 2013, we performed left lateral segmentectomies in 60 patients, those excluded from analysis included previous liver resections, polycystic liver disease and liver cirrhosis. Laparoscopic left lateral segmentectomy was performed in 30 patients and open left lateral segmentectomy was performed in 20 patients. All clinical data were analyzed retrospectively. RESULTS: The mean duration of operation was 120 ± 30.4 min in the LLS and 150 ± 36.8 min in the OLS group, no statistically significant difference was found between the two groups. The median blood loss in LLS group was less than that in OLS group (200 ± 22.1 ml versus 328 ± 36.8 ml, P < 0.05). Mean post-operative hospital stay was significantly lower in LLS compared with OLS (5 ± 0.9 vs. 8 ± 1.0; P < 0.05). The postoperative morbidity rate was also significantly different between the groups, a tendency towards more severe complications in the OLS group compared with LLS group. CONCLUSION: Laparoscopic left lateral segmentectomy can decrease complications, shorten hospitalization time, is a minimally invasive, safe and effective way.

Hepatectomía laparoscópica en tumor sólido benigno: informe de un caso / Laparoscopic hepatectomy in benign solid tumor: case report

Introducción: La cirugía hepática laparoscópica representa una alternativa quirúrgica para abordar tumores sólidos menores a 5 cm ubicados en el lóbulo izquierdo y en segmentos anteriores del lóbulo derecho. El objetivo de este informe es presentar la primera resección hepática por vía laparocópica reportada en Venezuela, así como revisión en la literatura. Caso clínico: Mujer de 40 años de edad, quien ingresó al servicio de Cirugía General del Hospital Universitario de Maracaibo con dolor en epigastrio de leve intensidad, de un año de evolución, además de masa palpable a ese nivel, con exámenes de laboratorio y marcadores tumorales dentro de la normalidad. Por ultrasonido abdominal se identificó una lesión focal en los segmentos II y III del hígado de 5.8 × 4.3 cm aproximadamente, confirmada por tomografía axial computarizada. Se practicó segmentectomía laparoscópica lateral izquierda a través de cuatro puertos de acceso; el tiempo quirúrgico fue de 245 minutos, con 350 ml de sangrado; se extrajo la pieza completa a través de una incisión transversal suprapúbica. La evolución posoperatoria fue satisfactoria. La paciente no ameritó ingreso en terapia intensiva y egresó al cuatro día. La biopsia definitiva indicó adenoma hepatocelular. Conclusiones: El abordaje laparoscópico es otra alternativa con menor morbimortalidad en el manejo quirúrgico de lesiones solidas de hígado, como se reporta en la literatura revisada.

BACKGROUND: Laparoscopic liver surgery represents an alternative surgical approach in the presence of smaller solid tumors up to 5 cm located in the left lobe and in anterior segments of the right lobe. The objective of this report is to present the first hepatic resection by laparoscopy, reported in Venezuela, as well as also the review in the literature. CLINICAL CASE: A 40-year-old female was referred to the Surgical Service of the Hospital Universitario de Maracaibo for mild epigastric pain of 1-year evolution, in addition to having a palpable mass in the same region; laboratory tests and tumor markers was normal. Complementary studies such as computed abdominal tomography and ultrasound revealed a lesion of 5.8 x 4.3 cm, localized in segments II and III of the liver. The patient underwent surgery, and a left lateral segmentectomy was performed using laparoscopy in four access ports. Surgical time was approximately 245 min with bleeding of 350 cc. The liver segment was resected through a transverse suprapubic incision. The patient had a satisfactory postoperative evolution without the necessity of the intensive care unit and with a hospital stay of 4 days. Final pathological report demonstrated hepatocellular adenoma. CONCLUSIONS: Laparoscopic approach is another alternative in the surgical management of solid liver lesions. Lower mortality and morbidity are reported.