Hepatic pedicle-first approach for laparoscopic anatomical hepatectomy for the central segments: 19 cases report / 中华肝胆外科杂志

ABSTRACT

Objective:To assess the safety and feasibility of hepatic pedicle-first approach laparoscopic anatomical hepatectomy for central segments.Methods:The clinical data of 19 patients with hepatocellular carcinoma who underwent hepatic pedicle-first approach laparoscopic anatomical hepatectomy for the central segments in the Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital from September 2020 to January 2023 were retrospectively analyzed. In this procedure, hepatic pedicles of the central segments were divided first to delineate the ischemic demarcation and guide the liver parenchymal transection. The methods of operation, operation time, intraoperative blood loss, postoperative complications and hospital-stay were analyzed.Results:Hepatic pedicle-first approach laparoscopic anatomical hepatectomy for the central segments was successfully performed in all patients, including 5 cases of segment Ⅳ, 2 cases of segment Ⅳ+ Ⅷ, 3 cases of segment Ⅳ+ ventral segment Ⅷ, 3 cases of segment Ⅳa+ Ⅴ+ Ⅷ and 6 cases of segment Ⅴ+ Ⅷ. The mean operation time, intraoperative blood loss and postoperative hospital stay was (253.1±86.1) min, [ M( Q1, Q3)] 100.0(100.0, 250.0) ml, and (5.1±1.2) d respectively. There was no intraoperative blood transfusion and postoperative complications. Conclusion:Hepatic pedicle-first approach can help delineate the segemental demarcation in laparoscopic anatomical hepatectomy for the central segments, which is technically feasible and worth more practice.