Han Ho-Seong, Cho Jai Young, Yoon Yoo-Seok
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
J Hepatobiliary Pancreat Surg. 2009;16(4):427-32. doi: 10.1007/s00534-009-0118-2. Epub 2009 May 28.
Many studies have recently reported on laparoscopic liver resection, although its development has been slow compared to laparoscopy in other fields. The indications for the location of laparoscopic liver resection have previously been limited to easily accessible lesions. Performing laparoscopic liver resection in the posterior and superior parts of the liver has been considered difficult due to inadequate exposure, the poor operative field and the difficulty with parenchymal dissection. Flexible endoscopy, high definition imaging and various kinds of equipment for parenchymal transection have been introduced for clinical use. In addition, much experience with this procedure has been accumulated at many centers. Accordingly, there are an increasing number of reports on laparoscopic liver resection in difficult locations. At our institution, the location of the tumor is no longer a limitation to laparoscopic liver resection. However, for safer laparoscopic liver resection, the patient positioning and trocar placement should be individualized according to the tumor location. The type of resection also may depend on the remaining liver's functional capacity. We describe here the technical considerations for performing laparoscopic liver resection, including the technical considerations for performing laparoscopic liver resection for lesions located in the postero-superior segments of the liver.
最近有许多关于腹腔镜肝切除术的研究报道，尽管与其他领域的腹腔镜技术相比，其发展较为缓慢。以往腹腔镜肝切除术的适应证局限于易于暴露的病变。由于暴露不充分、手术视野不佳以及肝实质离断困难，在肝脏后部和上部进行腹腔镜肝切除术一直被认为具有挑战性。可弯曲内镜、高清成像以及各种肝实质离断设备已被引入临床应用。此外，许多中心积累了大量该手术的经验。因此，关于在困难部位进行腹腔镜肝切除术的报道越来越多。在我们机构，肿瘤位置已不再是腹腔镜肝切除术的限制因素。然而，为了更安全地进行腹腔镜肝切除术，患者体位和套管针放置应根据肿瘤位置个体化。切除方式也可能取决于剩余肝脏的功能容量。在此，我们描述进行腹腔镜肝切除术的技术要点，包括针对位于肝脏后上段病变进行腹腔镜肝切除术的技术要点。
