Background: Laparoscopic anatomic hepatectomy(LAH)has gradually become the routine surgical procedure. We reported previously that Glissonian approach combined with major hepatic vein first was effective for LAH. Owing to Dorsal approach could expose the major hepatic vein effectively, we merged dorsal approach and Glissonian approach in LAH for right lobe.
Methods: Twenty patients who underwent LAH from January 2017 to November 2018 were retrospectively analyzed. These comprised seven patients who underwent laparoscopic right hemihepatectomy (group LRH), seven patients who underwent laparoscopic right posterior hepatectomy (group LRPH), and six patients who underwent laparoscopic hepatectomy for segment 7 (group LS7). Firstly, the corresponding hepatic pedicles were isolated through Glissonian approach. Next, the liver parenchyma was transected by dorsal approach until the corresponding major hepatic vein was exposed. Then liver parenchyma was transected by a ventral approach. Finally, the root of the major hepatic vein was transected.
Results: The mean age of the patients was 53.8 years and the male: female ratio was 8:12. The median operation time was 306.0 ± 58.2 min and the mean estimated volume of blood loss was 412.5 ± 255.4 mL. The mean duration of postoperative hospital stay was 10.2 days. The mean Pringle maneuver time was 64.8 ± 27.7 min. Five patients received transfusion of 2–4 U of red blood cells. Two patients suffered from transient hepatic dysfunction and one from pleural effusion. No patient underwent conversion to an open procedure. The operative duration, volume of the blood loss, Pringle maneuver time, and postoperative hospital stay duration did not differ significantly among groups LRH, LRPH, and LS7 (P > 0.05).
Conclusion: Dorsal approach combined with Glissonian approach for right lobe in LAH is feasible and effective, though, it is essential to include more cases for further study.