Laparoscopic Left Lateral Segmentectomy

(1)

Department of General Surgery, Sir Run Run Shaw Hospital Zhejiang University, Hangzhou, China

Electronic supplementary material

The online version of this chapter at (doi: 10.1007/978-94-017-9840-2_3) contains supplementary material, which is available to authorized users.

In 1996, laparoscopic left lateral segmentectomy was reported by Azagra et al. (1996). For now, this procedure can be performed in most institutes of hepato-biliary-pancreatic surgery worldwide. Furthermore, laparoscopic left lateral segmentectomy was supposed to be a standard practice according to “The Louisville Statement” (Buell et al. 2009). Management of the hepatic pedicle is the point of this laparoscopic procedure. In some cases, the branches of the hepatic artery could be dissected outside the liver parenchyma before liver transection. The falciform ligament (FL) and the fissure for ligamentum teres (FLT) are the anatomical lines for liver transection along which the secondary branches of the portal vein and the hepatic artery can be well managed by meticulous dissection and the left lateral segment can be anatomically resected.

3.1 Indications and Contraindications

The indications include liver tumors in lateral segment or left intrahepatic bile duct stones with irreversible diseases (biliary stricture, severe parenchymal fibrosis or atrophy) requiring left lateral segmentectomy and liver function of Child A to B classification. The contraindications include history of biliary surgeries such as exploration of common bile duct or cholangiojejunostomy (cholecystectomy is not regarded as a contraindication), extrahepatic bile duct stricture, or acute suppurative cholangitis.

3.2 Patient Position and Trocars’ Position

Patients are placed in the supine position under general anesthesia. Three surgeons are needed in the operation. As shown in Fig. 3.1, the senior surgeon stands on the left side of the patient, one assistant surgeon stands on the right side of the senior surgeon manipulating the aspiration device, and the other assistant surgeon stands on the right side of the patient. Four entries are made. A supraumbilical 10-mm trocar is inserted as the observation port. A 12-mm trocar below the left costal margin is inserted as the main manipulation port. And two 5-mm trocars are inserted at the right flank area as assistant manipulation ports.

Fig. 3.1

The trocars’ position and surgeons’ position. (A) Observation port; (B) Main manipulation port; (C) Two assistant ports and the incision for removing specimen; (a) The senior surgeon stands on the left side of the patient; (b) One assistant on the right side of the surgeon controlling the aspiration device; (c) The other assistant stands on the right side of the patient