Departments of Surgery, Fukuyama City Hospital, Hiroshima, Japan.
Departments of Surgery, Fukuyama City Hospital, Hiroshima, Japan.
Surg Oncol. 2020 Dec;35:299-300. doi: 10.1016/j.suronc.2020.08.029. Epub 2020 Aug 30.
Laparoscopic anatomic segmentectomy 8 is a difficult and technically demanding procedure owing to exposure of two major hepatic veins. To safely and accurately perform this procedure, the outer-Laennec approach was developed (Kiguchi et al., 2019) [1], which is based on the structure of Laennec's capsule (Sugioka et al., 2017; Laennec, 1802; Hayashi et al., 2008) [2,3,4]. The capsule comprises two layers: the hepatic and cardiac Laennec's capsules surrounding the major hepatic vein (Kiguchi et al., 2019) [1]. The outer-Laennec approach maintains the strength of the hepatic vein wall, preserving the two layers of Laennec's capsule. We describe a laparoscopic anatomic segmentectomy 8 using the outer-Laennec approach for hepatocellular carcinoma (HCC).
Parenchymal transection was initiated to expose the root of the middle hepatic vein and right hepatic vein with the cranio-caudal view. The space between the hepatic Laennec's capsule and liver parenchyma was invaded using the outer-Laennec approach. The cavitron ultrasonic surgical aspirator was used from the root side toward the peripheral side to retain the hepatic Laennec's capsule on the vein wall and avoid splitting the bifurcation of the hepatic vein. The parenchymal dissection process was completed by an S8 Glissonean pedicle dissection.
The operative time was 296 min, and the estimated blood loss was 10 mL. The postoperative course was uneventful, and the patient was discharged on postoperative day 5. A pathological examination confirmed that the 2.0-cm mass was HCC with negative margins.
The outer-Laennec approach is feasible and useful to standardize the safe laparoscopic anatomic segmentectomy 8.
腹腔镜解剖性肝段切除术 8 是一项困难且技术要求较高的手术，因为需要暴露两条主要肝静脉。为了安全、准确地进行该手术，开发了外 Laennec 入路（Kiguchi 等人，2019）[1]，该入路基于 Laennec 囊的结构（Sugioka 等人，2017；Laennec，1802；Hayashi 等人，2008）[2,3,4]。该囊由两层组成：围绕主要肝静脉的肝 Laennec 囊和心 Laennec 囊（Kiguchi 等人，2019）[1]。外 Laennec 入路保持了肝静脉壁的强度，保留了两层 Laennec 囊。我们描述了一种使用外 Laennec 入路进行的腹腔镜解剖性肝段切除术 8 治疗肝细胞癌（HCC）的方法。
采用头足位暴露肝中静脉和右肝静脉根部，开始肝实质离断。使用外 Laennec 入路侵犯肝 Laennec 囊与肝实质之间的空间。从根部向边缘使用 Cavitron 超声外科吸引器保留肝 Laennec 囊在静脉壁上，避免肝静脉分叉分离。通过 S8 肝 Glissonean 蒂解剖完成实质解剖过程。
手术时间为 296 分钟，估计出血量为 10 毫升。术后过程平稳，患者于术后第 5 天出院。病理检查证实 2.0 厘米的肿块为 HCC，切缘阴性。
外 Laennec 入路是可行的，有助于规范安全的腹腔镜解剖性肝段切除术 8。
