Laparoscopic right hemihepatectomy with augmented reality
Epublication WebSurg.com, May 2015;15(05). URL: http://websurg.com/doi/vd01en4421
We report the case of a 42-year-old woman who underwent a laparoscopic right hemihepatectomy for a hepatic metastasis. The intervention is begun with the exploration of the entire peritoneal cavity and an intraoperative ultrasound exam of the liver. The lesion is identified by means of augmented reality. Dissection of the different vascular structures is then performed at the level of the hepatic pedicle. A clamping test of the right branches is achieved. The right branch of the hepatic artery and the right portal vein are clamped, hence creating the demarcation area, which is identified by means of the coagulating hook. Declamping of portal and arterial structures coursing towards the right liver is achieved. The right branch of the portal vein is divided between two clips. The right branch of the hepatic vein is also divided between two clips. After mobilization of the right liver, the hepatotomy is begun. The first superficial centimeters are divided using an ultrasonic dissector (Ultracision®). Dissection is then carried on by means of a Cusa® Dissectron® Ultrasonic Surgical Aspirator. The largest structures are subsequently dissected intraparenchymally, and then clipped and divided. Hemostasis is completed using a radiofrequency instrument. The right biliary tract is dissected intraparenchymally, clipped and divided. The right hepatic vein is divided by means of a stapler. The specimen is placed in a bag, which is extracted by means of a small Pfannenstiel incision. Hemostasis is controlled as the pneumoperitoneum is reduced. A blade is positioned in the hepatectomy area.