Strategies and techniques of laparoscopic anatomical clockwise four-section mesohepatectomy

Objective To explore the surgical techniques and keypoints of laparoscopic anatomical mesohepatectomy. Methods Clinical data of 12 patients with liver cancer who underwent laparoscopic anatomical mesohepatectomy in Guangdong Provincial Hospital of Traditional Chinese Medicine from March 2017 to January 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 9 patients were male and 3 female, aged 43-72 years old with a median age of 55 years old. The porta hepatis was dissected, and the right anterior and left medial lobe pedicles were exposed and suspended to control the hemorrhage. Laparoscopic anatomical clockwise four-section mesohepatectomy was employed to separate the left, foot, right and head sections. Perioperative conditions of patients were observed. Results The operations of all patients were completed successfully without conversion to open surgery or perioperative death. The median operation time was 226(177-288) min and the intraoperative blood loss was 295(50-800) ml. Postoperative pleural effusion occurred in 1 case and bile leakage in 1 case, which were cured by conservative treatments. Liver function was basically restored to normal at postoperative 7 d. The average length of postoperative hospital stay was (6.5±2.3) d. Conclusions Laparoscopic mesohepatectomy isa challenging procedure. Laparoscopic clockwise four-section mesohepatectomy is a safe and feasible option, when the liver section is decided appropriately and intraoperative hemorrhage is controlled effectively. Key words: Laparoscopes; Hepatectomy; Blood loss, surgical