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Review
. 2019 Dec;8(6):572-581.
doi: 10.21037/hbsn.2019.04.16.

Techniques for laparoscopic liver parenchymal transection

Tomoaki Yoh  1   2   3 , François Cauchy  1   2   3 , Olivier Soubrane  1   2   3
Affiliations
Review

Techniques for laparoscopic liver parenchymal transection

Tomoaki Yoh et al. Hepatobiliary Surg Nutr. 2019 Dec.

Abstract

Laparoscopic liver surgery has gained wide acceptance resulting in a paradigm shift of liver surgery. Technical innovations and accumulation of surgeon's experience have allowed laparoscopic liver resection (LLR) to become an effective procedure with favorable peri- and post-operative outcomes. Through the overall process of LLR, liver parenchymal transection remains the most critical step with the aim of minimizing blood loss and secures the appropriate cutting line, i.e., securing major vessels and obtaining adequate surgical margin clearance for malignancies. Multiple preoperative imaging modalities and intraoperative ultrasonography findings may contribute to the best determination of the appropriate cutting line during the LLR; however, technical expertise in minimizing and controlling bleeding during liver parenchymal transection is still a challenge for safe LLR, and therefore represents a major concern for hepatobiliary surgeons. Along with the historical fact that the technique of liver parenchymal transection itself is chosen according to surgeon's preference and "savoir-faire", the best technical modality in laparoscopic liver parenchymal transection remains to be determined. However, better understanding the technical issue may serve a contribution to the standardization of LLR. This review article therefore focuses on the technical aspects of the laparoscopic liver parenchymal transection.

Keywords: Technique; laparoscopy; liver parenchymal transection.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The surgeon position, trocar placement and the concept of triangulation in laparoscopic right hepatectomy.
Figure 2
Figure 2
Techniques for laparoscopic liver parenchymal transection. (A) Transecting superficial layer of the liver by ultrasonic scalpel; (B) exposing intra-parenchyma structures with CUSA and bipolar cautery (right hepatectomy); (C) technique of hanging hepatic vein up, which allows for secured clipping; (D) transection of hepatic vein with laparoscopic vascular stapler (right hepatic vein). CUSA, cavitron ultrasonic surgical aspirator.
Figure 3
Figure 3
Extracorporeal clamping technique using a dedicated vascular clamp (68). Available online: http://www.asvide.com/watch/33018
Figure 4
Figure 4
Management of bleeding from vena cave during right hepatectomy (69). Available online: http://www.asvide.com/watch/33019
See this image and copyright information in PMC

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