Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, China.
Department of Operation Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.
Surg Endosc. 2022 Oct;36(10):7859-7860. doi: 10.1007/s00464-022-09448-8. Epub 2022 Sep 7.
With the advancement of laparoscopic technology, more precise anatomical hepatectomies such as segmentectomy or even bi-segmentectomy have been recommended by updated expert consensus to treat a single small hepatocellular carcinoma (HCC) [1, 2]. Herein, we presented a video of laparoscopic anatomic bi-segmentectomy (S3 and S4b) using the Glisson's pedicle-first and intrahepatic anatomic markers approach.
A 66-year-old male was referred for treatment of a single HCC adjacent to the Sagittal part of the left portal vein. The procedure was performed according to the following steps: (1) dissecting and transecting the Glisson's pedicle to S3 and S4b based on Laennec's capsule [3]; (2) identification of the ischemia boundary on the liver surface and confirming the presence of adequate surgical margins within the boundary, ensuing the integrity of segment 2 and 4a by the intraoperative ultrasonography meanwhile; (3) the left parenchymal transection was begun along the demarcation line, exposing the Glisson's pedicle to S2, left hepatic vein, and umbilical fissure vein; (4) the right parenchymal transection was performed to expose the V5, V4b, and V4a. And this operation was approved by the Institutional Review Board of the West China Hospital and written informed consent was obtained from patient of Sichuan University and written informed consent was obtained from patient. (5) The blood supply of residual liver surface was observed, and the integrity of segment 2 and 4a hepatic pedicle was ensured by intraoperative ultrasonography.
The operative time was 224 min and blood loss during operation was 50 ml. The histopathologic examination showed a solitary HCC, 4 cm in diameter, with negative surgical margin and no microvascular invasion. The patient had an uneventful postoperative recovery and was discharged on postoperative day 5.
Laparoscopic bi-segmentectomy (S3 and S4b) using the Glisson's pedicle-first and intrahepatic anatomic markers approach is feasible and effective. Its advantages lie in obtaining the benefits of anatomical hepatectomy, while maximizing the postoperative functional hepatic reserve [4-6].
随着腹腔镜技术的进步，更新的专家共识建议进行更精确的解剖性肝切除术，如肝段切除术甚至双段切除术，以治疗单个小肝细胞癌（HCC）[1,2]。在此，我们展示了一段使用 Glisson 蒂优先和肝内解剖标志物方法行腹腔镜解剖性双段切除术（S3 和 S4b）的视频。
一名 66 岁男性因单个 HCC 毗邻左门静脉矢状部而被转诊治疗。该手术按以下步骤进行：（1）根据 Laennec 囊[3]解剖和横断 Glisson 蒂至 S3 和 S4b；（2）在肝表面识别缺血边界，并确认边界内有足够的手术切缘，同时通过术中超声确认 2 段和 4a 段的完整性；（3）沿分界线开始左肝实质切开，显露 S2、左肝静脉和脐裂静脉的 Glisson 蒂；（4）进行右肝实质切开以显露 V5、V4b 和 V4a。本操作经华西医院机构审查委员会批准，并获得四川大学患者的书面知情同意。（5）观察残肝表面的血供，并通过术中超声确保 2 段和 4a 肝蒂的完整性。
手术时间为 224 分钟，术中出血量为 50 毫升。组织病理学检查显示为单个 HCC，直径 4 厘米，切缘阴性且无微血管侵犯。患者术后恢复顺利，术后第 5 天出院。
使用 Glisson 蒂优先和肝内解剖标志物方法行腹腔镜双段切除术（S3 和 S4b）是可行且有效的。其优点在于获得解剖性肝切除术的益处，同时最大限度地提高术后功能性肝储备[4-6]。
