Lessons Learned from the First Experience of Laparoscopic Right Posterior Sectionectomy
EAES Academy. LEE 이. 07/05/22; 366518; P235
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Laparoscopic right posterior sectionectomy (RPS) is one of the most technically challenging procedure. The purpose of the video article is to describe the difficulties and pitfalls from first experience of laparoscopic RPS and to share the tips for beginner; experienced senior surgeons share his advice for laparoscopic RPS.
Case presentation: The patient was a 79-year-old male was referred for hepatectomy because of a 4.2 cm sized hepatocellular carcinoma (HCC) at the right posterior section (RPS). Initially, a cholecystectomy and mobilization of right liver was performed in the usual manner. [Challenging 1) Inflow control] This part of the operation is technically demanding, especially in the hand of beginners. However, adequate access to right posterior glisson (RPG) is essential. If it is difficult to completely isolation of the RPG using sling, a bulldog clamp can be applied for inflow control. [Challenging 2) Parenchymal dissection] The laparoscopic RPS requires a longer parenchymal transection distance than right hepatectomy. Thus, we should reduce the bleeding from the resection line during identification and dissection of blood vessels and biliary tracks. If uncontrolled bleeding occurs at multiple points, the gauze compression methods can be used to reduce bleeding from the resection margin. [Challenging 3) Exposure of right hepatic vein (RHV)] The RHV should be exposed to obtain an adequate resection margin. If the RHV exposure is difficult, the use of intraoperative ultrasonography as an aid to liver resection.
Conclusion: The laparoscopic RPS is feasible safe when performed in experienced surgeons. However, it is a complex and difficult procedure for young surgeons, including controlling the inflow, reducing the risk of bleeding and ensuring an adequate the resection margin. Before overcoming the learning curve, the young surgeon must be balanced between patient safety and surgical steps.
Case presentation: The patient was a 79-year-old male was referred for hepatectomy because of a 4.2 cm sized hepatocellular carcinoma (HCC) at the right posterior section (RPS). Initially, a cholecystectomy and mobilization of right liver was performed in the usual manner. [Challenging 1) Inflow control] This part of the operation is technically demanding, especially in the hand of beginners. However, adequate access to right posterior glisson (RPG) is essential. If it is difficult to completely isolation of the RPG using sling, a bulldog clamp can be applied for inflow control. [Challenging 2) Parenchymal dissection] The laparoscopic RPS requires a longer parenchymal transection distance than right hepatectomy. Thus, we should reduce the bleeding from the resection line during identification and dissection of blood vessels and biliary tracks. If uncontrolled bleeding occurs at multiple points, the gauze compression methods can be used to reduce bleeding from the resection margin. [Challenging 3) Exposure of right hepatic vein (RHV)] The RHV should be exposed to obtain an adequate resection margin. If the RHV exposure is difficult, the use of intraoperative ultrasonography as an aid to liver resection.
Conclusion: The laparoscopic RPS is feasible safe when performed in experienced surgeons. However, it is a complex and difficult procedure for young surgeons, including controlling the inflow, reducing the risk of bleeding and ensuring an adequate the resection margin. Before overcoming the learning curve, the young surgeon must be balanced between patient safety and surgical steps.
Laparoscopic right posterior sectionectomy (RPS) is one of the most technically challenging procedure. The purpose of the video article is to describe the difficulties and pitfalls from first experience of laparoscopic RPS and to share the tips for beginner; experienced senior surgeons share his advice for laparoscopic RPS.
Case presentation: The patient was a 79-year-old male was referred for hepatectomy because of a 4.2 cm sized hepatocellular carcinoma (HCC) at the right posterior section (RPS). Initially, a cholecystectomy and mobilization of right liver was performed in the usual manner. [Challenging 1) Inflow control] This part of the operation is technically demanding, especially in the hand of beginners. However, adequate access to right posterior glisson (RPG) is essential. If it is difficult to completely isolation of the RPG using sling, a bulldog clamp can be applied for inflow control. [Challenging 2) Parenchymal dissection] The laparoscopic RPS requires a longer parenchymal transection distance than right hepatectomy. Thus, we should reduce the bleeding from the resection line during identification and dissection of blood vessels and biliary tracks. If uncontrolled bleeding occurs at multiple points, the gauze compression methods can be used to reduce bleeding from the resection margin. [Challenging 3) Exposure of right hepatic vein (RHV)] The RHV should be exposed to obtain an adequate resection margin. If the RHV exposure is difficult, the use of intraoperative ultrasonography as an aid to liver resection.
Conclusion: The laparoscopic RPS is feasible safe when performed in experienced surgeons. However, it is a complex and difficult procedure for young surgeons, including controlling the inflow, reducing the risk of bleeding and ensuring an adequate the resection margin. Before overcoming the learning curve, the young surgeon must be balanced between patient safety and surgical steps.
Case presentation: The patient was a 79-year-old male was referred for hepatectomy because of a 4.2 cm sized hepatocellular carcinoma (HCC) at the right posterior section (RPS). Initially, a cholecystectomy and mobilization of right liver was performed in the usual manner. [Challenging 1) Inflow control] This part of the operation is technically demanding, especially in the hand of beginners. However, adequate access to right posterior glisson (RPG) is essential. If it is difficult to completely isolation of the RPG using sling, a bulldog clamp can be applied for inflow control. [Challenging 2) Parenchymal dissection] The laparoscopic RPS requires a longer parenchymal transection distance than right hepatectomy. Thus, we should reduce the bleeding from the resection line during identification and dissection of blood vessels and biliary tracks. If uncontrolled bleeding occurs at multiple points, the gauze compression methods can be used to reduce bleeding from the resection margin. [Challenging 3) Exposure of right hepatic vein (RHV)] The RHV should be exposed to obtain an adequate resection margin. If the RHV exposure is difficult, the use of intraoperative ultrasonography as an aid to liver resection.
Conclusion: The laparoscopic RPS is feasible safe when performed in experienced surgeons. However, it is a complex and difficult procedure for young surgeons, including controlling the inflow, reducing the risk of bleeding and ensuring an adequate the resection margin. Before overcoming the learning curve, the young surgeon must be balanced between patient safety and surgical steps.
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