Feasibility of totally laparoscopic hemi-hepatectomies for liver tumor, with consideration of correspondence for difficult cases

Abstract

Aim: Laparoscopic liver resection (LLR) has been recognized as a minimally invasive surgery offering disease curability for liver tumors. Moreover, recent publications suggest that the systematic liver resections including hemi-hepatectomies have been performed safely in high volume centers. We describe our indication, standardized technique, and surgical outcome for totally laparoscopic hemi-hepatectomy (TLHH). Moreover, we hypothesize that TLHHs can be performed feasibly, as well as discuss the technical correspondence of technically difficult cases which have marginal indication for TLHHs.

Methods: From September 2008 to July 2020, in total, 488 cases of liver resections including 222 cases of LLR were performed in our institution. We invented the favorable indication of TLHHs of locally resectable tumors without involvement of tumor to hepatic hilus, confluence of hepatic veins, inferior vena cava, or extrahepatic organs, in patients with sufficient hepatic functional reserve for hemi-hepatectomies. Among 21 TLHHs for liver tumors performed during study period, there were cases which derogate favorable indications; however, they might have been able to undergo TLHHs. We divided these cases into “difficult indication group (DIG)” (10 of 21 cases) and “favorable indication group (FIG)”; compared them on perioperative background, surgical outcome; and discussed the technical correspondence of TLHHs on DIG.

Results: There were no significant differences in patient’s background and operative outcome. Operative duration, blood loss, and postoperative morbidity tended to be larger in DIG, mainly due to tumor factor, than in FIG. However, TLHHs were performed without any severe perioperative complications beyond Clavien-Dindo grade IIIb or mortality.

Conclusion: We believe that hemi-hepatectomies can safely be stylized by totally laparoscopic fashion and correspondence for difficulty can be made through technical standardization.

Keywords

Laparoscopic liver resection / major hepatectomy / laparoscopic hepatectomy / hemi-hepatectomy / liver tumor

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