Laparoscopic resection of a hepatocellular carcinoma within segment IVa of the liver

This video presents the case of a female patient with an ethylic cirrhosis, diagnosed with a hepatocellular carcinoma located in segment IVa of the liver. The laparoscopic approach helps preserve liver function in patients with precarious liver conditions.

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Laparoscopic   resection   of   a   hepatocellular   carcinoma   within   segment   IVa   of   the   liver

Authors
D Mutter, J Marescaux, L Soler
Abstract
This video presents the case of a female patient with an ethylic cirrhosis, diagnosed with a hepatocellular carcinoma located in segment IVa of the liver. The laparoscopic approach helps preserve liver function in patients with precarious liver conditions.
Classification
complex cases
Keywords
laparoscopy, resection, hepatocellular carcinoma, segment IVa of liver, hepatectomy, liver resection, cancer
Media type
Duration
08'24''
Publication
2008-09
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Subtitles
en
E-publication
WeBSurg.com, Sept 2008;8(09).
URL: http://www.websurg.com/doi-vd01en2390.htm

Laparoscopic   resection   of   a   hepatocellular   carcinoma   within   segment   IVa   of   the   liver

4. Superficial tagging of the tumor and dissection 02'13''
The resection started afterwards without any Pringle’s manoeuvre; this was done in order to avoid any lesion of the remaining liver. We draw on the liver using electrocautery a one centimetre margin that we wanted to respect in this resection. As we can see, this required to resect a little part of segment 3 partially. The whole dissection was performed with three instruments, one held by the left hand of the surgeon, which was the bipolar cautery. The right hand of surgeon could manage an ultrasonic dissector and an AutoSonic device. The assistant was ready with a suction device in case of sudden bleeding. The whole procedure was performed with 4 trocars. The ultrasonic dissector is a very interesting tool for the dissection of the parenchyma. Nevertheless, the depth of the hemostasis that is performed with this device is not enough to control all types of bleeding. On the periphery of the resection, cauterization was always completed with bipolar cautery. The dissection was performed stepwise from the right side to the left side and from the left side to the right side regarding the little bleeding areas. If there is small bleeding, it is first controlled with bipolar cautery as you can see here, and then this region was compressed and the dissection was continued in another place anteriorly, laterally or posteriorly. Regarding this progressive dissection, first the resection margin of one centimetre was preserved. There was no significant bleeding despite the lack of major vascular control in this patient. The resection area was always controlled using a tape measure in order to be sure to respect the one centimetre margin of resection from the tumor. This means that a depth of 2.5cm was required to have a safe resection of this 15mm tumor. The suction device was also used as a retractor when necessary. The suction device allowed us to have a very clear operative field during the use of monopolar, bipolar cautery or during the use of the Harmonic dissector. Mobilization of the specimen can also be done using a small peanut, which is a very safe and very smooth atraumatic device that allows to mobilize the tumor without any disruption of the hepatic tissue. Here again, we can see that the suction device can also be used by the left hand of the surgeon who then places the instrument in his right hand. Dissection is then progressively completed and as planned, no major vessel is injured during this dissection. The specimen is freed, the resection area is controlled and if there are some bleeding points, further bipolar cautery is used.