Ogiso Satoshi, Nomi Takeo, Araki Kenichiro, Conrad Claudius, Hatano Etsuro, Uemoto Shinji, Fuks David, Gayet Brice
Department of Digestive Pathology, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France.
Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Ann Surg Oncol. 2015 Dec;22 Suppl 3:S327-33. doi: 10.1245/s10434-015-4661-6. Epub 2015 Jun 12.
Despite diffusion of laparoscopic hepatectomy, the acquisition of necessary skills is not easy for open liver surgeons. Concepts and techniques have totally changed in laparoscopic hepatectomy compared with open hepatectomy, which is an underlying cause of a technical hurdle in laparoscopic hepatectomy. This study aimed to illustrate laparoscopy-specific concepts and techniques for hepatectomy.
Video footages of laparoscopic and open hepatectomies stored in the Institut Mutualiste Montsouris and Kyoto University were reviewed to define the differences in surgical view, surgical concept, and technical details, using left lateral sectionectomy (LLS) and right hepatectomy (RH) as representative examples.
By comparison with open LLS and RH, laparoscopy-specific procedures were identified with regard to surgical view, parenchymal transection, available landmarks, and vascular dissection. By laparoscopy, the surgical field was constantly viewed and accessed from the caudal side to the cranial side. Similarly, the parenchyma was divided, and intrahepatic vessels were dissected in the same direction. Laparoscopy-specific landmarks were identified for both LLS and RH, behind the liver.
The concepts and techniques in laparoscopic hepatectomy are totally different from those of open hepatectomy because of the different surgical views. Understanding the laparoscopy-specific concepts and techniques would facilitate safe and efficient execution of laparoscopic hepatectomy.
尽管腹腔镜肝切除术已得到广泛应用，但对于开放肝手术的外科医生来说，掌握必要的技能并非易事。与开放肝切除术相比，腹腔镜肝切除术的概念和技术已完全改变，这是腹腔镜肝切除术存在技术障碍的一个根本原因。本研究旨在阐述肝切除术的腹腔镜特定概念和技术。
回顾存储在蒙苏里互助会医院和京都大学的腹腔镜和开放肝切除术的视频片段，以左外侧段切除术（LLS）和右肝切除术（RH）作为代表性实例，确定手术视野、手术概念和技术细节方面的差异。
与开放LLS和RH相比，在手术视野、实质切开、可用标志和血管解剖方面确定了腹腔镜特定的操作方法。通过腹腔镜，手术视野始终从尾侧向头侧观察和进入。同样，实质以相同方向进行分割，肝内血管也以相同方向进行解剖。在LLS和RH中，均在肝脏后方确定了腹腔镜特定的标志。
由于手术视野不同，腹腔镜肝切除术的概念和技术与开放肝切除术完全不同。了解腹腔镜特定的概念和技术将有助于安全、高效地实施腹腔镜肝切除术。
