Kim Ji Hoon
Department of Surgery, Eulji University College of Medicine, Daejeon, Republic of Korea.
J Surg Oncol. 2017 Aug;116(2):159-163. doi: 10.1002/jso.24636. Epub 2017 Apr 14.
The laparoscopic caudal approach is very different from the open ventral approach, specifically with respect to the surgical view, which is completely different and is the underlying reason for why laparoscopic hepatectomy is technically challenging. We have introduced a new laparoscopy-specific ventral approach in laparoscopic hemihepatectomy.
The liver was transected from the ventral side to the dorsal side, via a flexible laparoscope, as in open liver resection. The key characteristic of the ventral approach is the early opening of the cranial part, which guides the accurate transection and maintains an open cutting plane. The middle hepatic vein is exposed from the root side toward the periphery.
From March to December 2016, this technique was performed on 12 patients. Of these patients, five underwent right hepatectomy, five underwent left hepatectomy, and two underwent extended left hepatectomy that included the middle hepatic vein. The median operative time was 250 min (range 210-350 min), and the median blood loss was 165 mL (range 100-260 mL). There was no postoperative morbidity or mortality. The median postoperative hospital stay was 8 days (range 5-14 days).
This ventral approach may be an effective and feasible technique for laparoscopic hemihepatectomy.
腹腔镜尾侧入路与开放腹侧入路有很大不同，特别是在手术视野方面，两者完全不同，这也是腹腔镜肝切除术在技术上具有挑战性的根本原因。我们在腹腔镜半肝切除术中引入了一种新的腹腔镜专用腹侧入路。
如同开放肝切除术一样，通过可弯曲腹腔镜从腹侧至背侧离断肝脏。腹侧入路的关键特征是早期打开肝上部，这有助于精确离断并保持开放的切割平面。从肝中静脉根部向周边显露肝中静脉。
2016年3月至12月，对12例患者实施了该技术。其中，5例行右肝切除术，5例行左肝切除术，2例行包括肝中静脉的扩大左肝切除术。中位手术时间为250分钟（范围210 - 350分钟），中位失血量为165毫升（范围100 - 260毫升）。无术后并发症或死亡病例。中位术后住院时间为8天（范围5 - 14天）。
这种腹侧入路可能是一种用于腹腔镜半肝切除术的有效且可行的技术。
