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Feasibility of purely laparoscopic right anterior sectionectomy

机译：纯腹腔镜右侧剖面切除术的可行性

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Background Right anterior sectionectomy is complex in comparison to other liver resections. Thus, the operation has not been widely performed via a laparoscopic approach. We herein present a purely laparoscopic method for right anterior sectionectomy using the standardized techniques. Methods Between May 2017 and December 2018, ten pure laparoscopic right anterior sectionectomies were performed for hepatic malignancy. To perform laparoscopic anatomical liver resection safely and securely, we developed an original surgical procedure based on the isolation of the targeted Glissonean pedicle at the hilum, with appropriate transection planes built sequentially according to anatomical landmarks. The extrahepatic right anterior Glissonean pedicle was isolated without parenchymal destruction by utilizing a unique view in the laparoscopic approach. The selective right anterior segment inflow was temporary occluded, consequently liver parenchymal transection consisted of four planes according to the demarcation line, middle hepatic vein (MHV), right anterior Glissonean pedicle, and right hepatic vein (RHV), which were used as anatomical landmarks. Transection was started between the demarcation line and ventral of the MHV (plane 1). Transection of the parenchyma was then performed from dorsal of the MHV to the right anterior Glissonean pedicle (plane 2). Parenchyma was then transected from dorsal of the RHV to the right anterior Glissonean pedicle (plane 3). We subsequently divide the right anterior Glissonean pedicle with a linear stapler. Finally, the resection plane was completed by performing parenchymal transection between the demarcation line and ventral of the RHV (plane 4). Results The mean operation time was 446 min with 334 ml of estimated blood loss. No cases required conversion to open surgery. Bile leakage occurred as a postoperative complication in one patient. There was no mortality. Conclusion Isolating the extrahepatic Glissonean pedicle at the hilum and transection along four planes determined according to anatomical landmarks made purely laparoscopic right anterior sectionectomy feasible.
机译：背景：与其他肝脏切除术相比，右前叶切除术比较复杂。因此，该手术尚未通过腹腔镜广泛实施。我们在此提出一种使用标准化技术的单纯腹腔镜右前叶切除术。方法2017年5月至2018年12月，10例单纯腹腔镜右前叶切除术治疗肝脏恶性肿瘤。为了安全、可靠地进行腹腔镜解剖性肝切除术，我们开发了一种基于分离肝门处靶向Glissonean蒂的原始手术方法，并根据解剖标志依次构建适当的横断平面。利用腹腔镜手术的独特视角，分离肝外右前Glissonean椎弓根，无实质性破坏。选择性右前节流入暂时闭塞，因此肝实质横断由四个平面组成，根据分界线，肝中静脉（MHV）、右前Glissonean蒂和右肝静脉（RHV）被用作解剖标志。横切开始于分界线和MHV腹侧之间（平面1）。然后从MHV背侧到右前格利森椎弓根（平面2）进行实质横断。然后从右室背侧到右前格利松椎弓根切断实质（平面3）。随后，我们用线性吻合器将右前Glissonean椎弓根分开。最后，通过在分界线和RHV腹侧之间进行实质横切完成切除平面（平面4）。结果平均手术时间446min，估计失血量334ml。无需中转开腹手术的病例。1例患者术后出现胆漏。没有死亡病例。结论在肝门处分离肝外Glissonean椎弓根，并沿根据解剖标志确定的四个平面横切，使单纯腹腔镜右前叶切除术成为可能。

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