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. 2023 Apr 17;85(5):1566-1570.
doi: 10.1097/MS9.0000000000000702. eCollection 2023 May.

Laparoscopic anatomical segmentectomy: A paradigm shift towards minimally invasive liver surgery in Nepal: A cohort study

Roshan Ghimire  1 , Aakash Mishra  1 , Yugal Limbu  1 , Sujan Regmee  1 , Dhiresh Kumar Maharjan  1 , Prabin Bikram Thapa  1
Affiliations

Laparoscopic anatomical segmentectomy: A paradigm shift towards minimally invasive liver surgery in Nepal: A cohort study

Roshan Ghimire et al. Ann Med Surg (Lond). .

Abstract

Laparoscopic liver resection is taking stride in slowly replacing open surgeries for various hepatic pathologies in many developed countries. However, due to high cost and lack of expertise, there are only a handful of centres in the low-medium income countries who perform advanced laparoscopic liver resections regularly. In this study, a prospective analysis was carried out to assess and report the outcomes of laparoscopic anatomical segmentectomy (LAS) from a single centre in Nepal.

Methods: The clinical data of all patients who underwent LAS between 1 October 2021 to 30 September 2022 were prospectively recorded. Demographics, pathological diagnoses, types of resections performed, perioperative parameters, postoperative length of stay, postoperative complications data and IWATE score were collected and analyzed. All operations were performed using the extrahepatic Glissonean technique with the use of indocyanine green dye as an adjunct during the intraoperative period.

Results: In the study period, a total of 16 LAS were performed in our centre for various indications. The mean age of the patients in the series was 41.6 years, and seven of 16 patients were male. The majority of the cases were segment 2/3 resection indicated for various pathologies and segment 4b/5 indicated for carcinoma gallbladder. The median hospital stay was 6 days and only two cases developed major complication. There were no mortalities in our series.

Conclusions: Taking into account the results produced from a single centre in a low-medium income country, laparoscopic anatomical segmentectomy is technically feasible with an acceptable safety profile.

Keywords: IWATE criteria; indocyanine green; laparoscopy; minimally invasive surgery; segmentectomy.

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Conflict of interest statement

The authors declare no conflicts of interest pertaining to this work.

Figures

Figure 1
Figure 1
Right posterior pedicle isolated and slinged.
Figure 2
Figure 2
Right posterior section demarcation in NIR light after ICG administration. ICG, indocyanine green; NIR, near-infrared.
Figure 3
Figure 3
HCC in left lateral segment under white light (background liver cirrhotic). HCC, Hepatocellular carcinoma.
Figure 4
Figure 4
HCC in left lateral segment under near-infrared light with ICG (ICG retention). ICG, indocyanine green; HCC, Hepatocellular carcinoma.
See this image and copyright information in PMC

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