The application to laparoscopic hepatectomy has not been actively developed because of the technical and anatomical difficulties. In this article we describe our surgical technique and the materials used in the experimental model of pigs.
A laparoscopic left lateral lobectomy was performed in six pigs.
The left medial and lateral lobes of the liver were grasped after four trocars were introduced. An ultrasonic surgical system was used to dissect the parenchyma. The portal vein and hepatic vein were carefully dissected free from surrounding tissue. The vascular pedicles were secured with an Endo-clip and/or transfixing suture, cut with the scissors or Endo-cutter. The resected liver was placed in a nylon sack (Endo-pouch) and removed through a trocar site by extending the incision.
A left lateral lobectomy was performed safely in all six pigs. Surgery required 90 to 130 minutes and blood loss was less than 100 ml except one animal. All pigs were stable condition. No bile leakage or site of bleeding was observed at autopsy.
The laparoscopic hepatectomy, especially partial hepatectomy or left lateral segmentectomy, in select number of patients is considered to be a feasible operation from the result of our experience.