Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan.
Medicine (Baltimore). 2024 Mar 1;103(9):e37336. doi: 10.1097/MD.0000000000037336.
The utility of the dorsal approach has been reported for laparoscopic left hemi-hepatectomy.
The aim of the present study is to show the usefulness of the dorsal approach for laparoscopic extended left-hemi-hepatectomy while ensuring safe identification of hepatic veins and dissection of the dorsal tumor margin.
Tumors requiring extended left hemi-hepatectomy.
After mobilization of the lateral sector and division of the Arantius plate, parenchyma above the Arantius plate is removed to expose the root of the middle hepatic vein and left hepatic vein. Each of these veins can be isolated separately either intra- or extra-hepatically. After removing the parenchyma on the cranial side of the left Glissonean pedicle continuous with the exposed hepatic veins, the left Glissonean pedicle is isolated using the Glissonean pedicle transection method. After division of the left hepatic vein and Glissonean pedicle, segment 4 (in which the main part of the tumor is commonly located) is dissected from the anterior plane of the paracaval portion of the caudate lobe by the dorsal approach, along with the hepatic hilum. Following dissection of the dorsal side of the tumor, and division of parenchyma from the anterior edge of the liver, the anterior Glissonean branches and middle hepatic vein are divided safely and the specimen is resected.
Three patients underwent laparoscopic extended left hemi-hepatectomy, with no open conversions. Operative time and blood loss were 331 (concomitant with another partial hepatectomy), 277, and 315 minutes; and 200, 100, and 100 g, respectively. The postoperative courses were uneventful.
The dorsal approach maximizes the advantages of laparoscopic extended left hemi-hepatectomy and can be performed safely.
腹腔镜左半肝切除术已报道背侧入路的实用性。
本研究旨在展示背侧入路在腹腔镜扩大左半肝切除术中的有用性，同时确保安全识别肝静脉和分离背侧肿瘤边界。
需要扩大左半肝切除术的肿瘤。
在外侧肝段游离和 Arantius 板分离后，切除 Arantius 板上方的肝实质，以暴露中间肝静脉和左肝静脉根部。这些静脉都可以在肝内或肝外单独分离。在切除与暴露的肝静脉连续的左 Glissonean 蒂头侧的肝实质后，使用 Glissonean 蒂切断法分离左 Glissonean 蒂。左肝静脉和 Glissonean 蒂切断后，沿背侧入路从尾状叶腔静脉旁前段解剖第 4 段（肿瘤的主要部分通常位于该段），同时解剖肝门。肿瘤背侧解剖和肝前缘肝实质分离后，安全地解剖和切断前 Glissonean 分支和中间肝静脉，并切除标本。
3 例患者接受腹腔镜扩大左半肝切除术，无中转开腹。手术时间和出血量分别为 331 分钟（同时行另一部分肝切除术）、277 分钟和 315 分钟；200 克、100 克和 100 克。术后过程均顺利。
背侧入路最大限度地发挥了腹腔镜扩大左半肝切除术的优势，可以安全进行。
