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Laparoscopic right hemihepatectomy
A laparoscopic right hemihepatectomy was performed for a gastric liver metastasis. After the dissection of the anatomical structure of the hepatic pedicle and an ultrasound examination, the right portal vein and the right branch of the hepatic artery were clamped, hence allowing to skeletonize the demarcation between the right liver and the left liver. The devascularization line was subsequently marked by means of electrocautery. The right hepatic branch and the right branch of the portal vein were divided between locked clips. The hepatotomy was started. The first very superficial centimeters were dissected using the Sonicision® Cordless Ultrasonic Dissection Device. No pedicular clamping was performed. The dissection followed the ischemic demarcation line between the right liver and the left liver. Hemostasis and biliostasis were completed using the Aquamantys® Bipolar Sealers. Once the first centimeters had been dissected, dissection was carried on using the CUSA™ ultrasonic dissector (Cavitron Ultrasonic Surgical Aspirator). Liver segment I was divided in order to open the posterior aspect of the hilar plate. The dissection was performed on the right border of the vena cava. The hilar plate was dissected, making it possible to control the right branch of the biliary tract intraparenchymally. The right hepatic vein was dissected and divided with an Endo GIA™ linear stapler. Makuuchi’s ligament was subsequently dissected and divided by means of a firing of the Endo GIA™ linear stapler, white cartridge. Mobilization of the right liver was completed by dividing the triangular ligament’s attachments at the level of the diaphragm. The right hepatectomy specimen was introduced into a bag, which was extracted through a suprapubic Pfannenstiel’s incision. Pneumoperitoneum pressure was diminished in order to control hemostasis and biliostasis.
P Pessaux, R Memeo, J Hallet, Z Cherkaoui, D Mutter, J Marescaux
Surgical intervention
1 year ago
7042 views
939 likes
0 comments
32:12
Laparoscopic right hemihepatectomy
A laparoscopic right hemihepatectomy was performed for a gastric liver metastasis. After the dissection of the anatomical structure of the hepatic pedicle and an ultrasound examination, the right portal vein and the right branch of the hepatic artery were clamped, hence allowing to skeletonize the demarcation between the right liver and the left liver. The devascularization line was subsequently marked by means of electrocautery. The right hepatic branch and the right branch of the portal vein were divided between locked clips. The hepatotomy was started. The first very superficial centimeters were dissected using the Sonicision® Cordless Ultrasonic Dissection Device. No pedicular clamping was performed. The dissection followed the ischemic demarcation line between the right liver and the left liver. Hemostasis and biliostasis were completed using the Aquamantys® Bipolar Sealers. Once the first centimeters had been dissected, dissection was carried on using the CUSA™ ultrasonic dissector (Cavitron Ultrasonic Surgical Aspirator). Liver segment I was divided in order to open the posterior aspect of the hilar plate. The dissection was performed on the right border of the vena cava. The hilar plate was dissected, making it possible to control the right branch of the biliary tract intraparenchymally. The right hepatic vein was dissected and divided with an Endo GIA™ linear stapler. Makuuchi’s ligament was subsequently dissected and divided by means of a firing of the Endo GIA™ linear stapler, white cartridge. Mobilization of the right liver was completed by dividing the triangular ligament’s attachments at the level of the diaphragm. The right hepatectomy specimen was introduced into a bag, which was extracted through a suprapubic Pfannenstiel’s incision. Pneumoperitoneum pressure was diminished in order to control hemostasis and biliostasis.
LIVE INTERACTIVE SURGERY: laparoscopic right hepatectomy in a patient with hepatocellular carcinoma (HCC) and metabolic syndrome
In this live interactive video, Professor Luc Soler provided a brief introduction of 3D reconstruction and modeling for precise tumor localization and future liver remnant before and after chemoembolization and right portal vein embolization. Dr. Soubrane briefly described the main principles, key steps, and preoperative planning in a 62-year-old male patient with hepatocellular carcinoma (HCC) and metabolic syndrome. He demonstrated the main technical aspects of port placement, hepatic pedicle dissection, exploration and dissection of vessels, and transection of liver parenchyma.
O Soubrane, P Pessaux, R Memeo, L Soler, D Mutter, J Marescaux
Surgical intervention
1 year ago
4426 views
570 likes
0 comments
51:19
LIVE INTERACTIVE SURGERY: laparoscopic right hepatectomy in a patient with hepatocellular carcinoma (HCC) and metabolic syndrome
In this live interactive video, Professor Luc Soler provided a brief introduction of 3D reconstruction and modeling for precise tumor localization and future liver remnant before and after chemoembolization and right portal vein embolization. Dr. Soubrane briefly described the main principles, key steps, and preoperative planning in a 62-year-old male patient with hepatocellular carcinoma (HCC) and metabolic syndrome. He demonstrated the main technical aspects of port placement, hepatic pedicle dissection, exploration and dissection of vessels, and transection of liver parenchyma.
Laparoscopic right hepatectomy on cirrhotic liver after transarterial chemoembolization (TACE) and portal vein embolization (PVE) for hepatocellular carcinoma (HCC)
We reported the case of a 70-year-old man in whom an F4 cirrhosis and a well-differentiated hepatocellular carcinoma were evidenced and managed by a laparoscopic right hepatectomy after transarterial chemoembolization and portal vein embolization. The operation starts with the control of the hepatic pedicle. A Doppler ultrasound is performed. It will reveal the relation of the lesion with the vein. The different right hepatic structures are identified, clipped and divided. Mobilization of the right liver is then initiated. The gallbladder, which is kept in place, is used for traction purposes. Parenchymal transection is begun with the assistance of Ultracision®, Aquamantys®, and Dissectron®. The portal structure and the hepatic vein are identified. The parenchymotomy is carried on and the identification of the right hepatic vein is going to be achieved. The origin of the right hepatic vein is dissected at its upper part and its lower part, in order to encircle it with a tape and divide it with a stapler. Once completed, the medial part of the right triangular ligament is further divided. Mobilization is continued on the same part from both sides, changing traction. The right liver is placed in a bag and removed. The cavity is cleansed. The hemostasis and biliostasis are controlled on the transection.
P Pessaux, R Memeo, J Hargat, S Tzedakis, D Mutter, J Marescaux, L Soler
Surgical intervention
3 years ago
2058 views
42 likes
0 comments
08:07
Laparoscopic right hepatectomy on cirrhotic liver after transarterial chemoembolization (TACE) and portal vein embolization (PVE) for hepatocellular carcinoma (HCC)
We reported the case of a 70-year-old man in whom an F4 cirrhosis and a well-differentiated hepatocellular carcinoma were evidenced and managed by a laparoscopic right hepatectomy after transarterial chemoembolization and portal vein embolization. The operation starts with the control of the hepatic pedicle. A Doppler ultrasound is performed. It will reveal the relation of the lesion with the vein. The different right hepatic structures are identified, clipped and divided. Mobilization of the right liver is then initiated. The gallbladder, which is kept in place, is used for traction purposes. Parenchymal transection is begun with the assistance of Ultracision®, Aquamantys®, and Dissectron®. The portal structure and the hepatic vein are identified. The parenchymotomy is carried on and the identification of the right hepatic vein is going to be achieved. The origin of the right hepatic vein is dissected at its upper part and its lower part, in order to encircle it with a tape and divide it with a stapler. Once completed, the medial part of the right triangular ligament is further divided. Mobilization is continued on the same part from both sides, changing traction. The right liver is placed in a bag and removed. The cavity is cleansed. The hemostasis and biliostasis are controlled on the transection.
Laparoscopic right hemihepatectomy with augmented reality
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.
P Pessaux, J Hallet, R Memeo, X Untereiner, L Soler, D Mutter, J Marescaux
Surgical intervention
4 years ago
2484 views
68 likes
0 comments
12:53
Laparoscopic right hemihepatectomy with augmented reality
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.
Laparoscopic right hepatectomy using hanging maneuver and Glissonian approach
Background: In open surgery for major hepatectomies, the Glissonian approach and liver hanging maneuver have proven useful. However, these techniques are not routinely applied in a laparoscopic context due to some intrinsic difficulty. Published techniques for laparoscopic major hepatectomy generally involve hilar dissection with separate transection of vasculo-biliary elements and anatomical parenchymal transection along the demarcation line. This video demonstrates the feasibility of the Glissonian approach and liver hanging maneuver that were performed for total laparoscopic right hepatectomy.
Methods: A 57-year-old woman suffering from huge liver mass was referred for surgical treatment. A total laparoscopic right hepatectomy was performed for this lesion. The operation followed 5 distinct phases: early hanging maneuver, extrahepatic extrafascial access to the right portal pedicle, parenchymal transection, control and division of the right hepatic vein, and complete mobilization of the right liver.
Results: Operative time was 400 min. The estimated blood loss was 150mL and no need for blood transfusion. The pathological examination confirmed an 8 by 6 by 7cm HCC with clear surgical margins. Patient recovery was uneventful, and the patient was discharged on postoperative day 6.
Conclusions Glissonian approach and hanging maneuver have proven to be safe and useful procedures for performing precise laparoscopic right hepatectomy.
R Chanwat, C Bunchaliew
Surgical intervention
4 years ago
3062 views
67 likes
0 comments
07:27
Laparoscopic right hepatectomy using hanging maneuver and Glissonian approach
Background: In open surgery for major hepatectomies, the Glissonian approach and liver hanging maneuver have proven useful. However, these techniques are not routinely applied in a laparoscopic context due to some intrinsic difficulty. Published techniques for laparoscopic major hepatectomy generally involve hilar dissection with separate transection of vasculo-biliary elements and anatomical parenchymal transection along the demarcation line. This video demonstrates the feasibility of the Glissonian approach and liver hanging maneuver that were performed for total laparoscopic right hepatectomy.
Methods: A 57-year-old woman suffering from huge liver mass was referred for surgical treatment. A total laparoscopic right hepatectomy was performed for this lesion. The operation followed 5 distinct phases: early hanging maneuver, extrahepatic extrafascial access to the right portal pedicle, parenchymal transection, control and division of the right hepatic vein, and complete mobilization of the right liver.
Results: Operative time was 400 min. The estimated blood loss was 150mL and no need for blood transfusion. The pathological examination confirmed an 8 by 6 by 7cm HCC with clear surgical margins. Patient recovery was uneventful, and the patient was discharged on postoperative day 6.
Conclusions Glissonian approach and hanging maneuver have proven to be safe and useful procedures for performing precise laparoscopic right hepatectomy.
Total laparoscopic right hepatectomy for large hepatoma using the Glissonian pedicle control with anterior approach
Background: Although laparoscopic liver resection has been widely adopted, performing a total laparoscopic right hepatectomy remains a challenging procedure, especially in patients with large tumor. This video illustrates a useful technique for total laparoscopic right hepatectomy which was successfully performed in patient with large hepatoma.

Methods: We demonstrate the case of a patient with a large tumor located in the right liver who underwent a total laparoscopic right hepatectomy. An anterior approach technique combined with Glissonian approach were used. The main steps of this technique are extraparenchymal control of right Glissonian pedicle en masse without liver dissection, parenchymal transection along the demarcation line, transection of right Glissonian pedicle, separation of whole right liver parenchyma, control and division of right hepatic vein and mobilization of the right liver from surrounding ligaments. No Pringle's maneuver was used.

Results: The technique was successfully performed without complication. Operative time was 560 min. Intraoperative blood loss was 1.100mL. The length of hospital stay was 6 days. The pathological report was well-differentiated HCC and free surgical margin.

Conclusion: Total laparoscopic right hepatectomy for large hepatoma by using the Glissonian pedicle control with anterior approach is feasible and safe.
R Chanwat, C Bunchaliew, T Khuhaprema
Surgical intervention
6 years ago
6236 views
40 likes
0 comments
09:19
Total laparoscopic right hepatectomy for large hepatoma using the Glissonian pedicle control with anterior approach
Background: Although laparoscopic liver resection has been widely adopted, performing a total laparoscopic right hepatectomy remains a challenging procedure, especially in patients with large tumor. This video illustrates a useful technique for total laparoscopic right hepatectomy which was successfully performed in patient with large hepatoma.

Methods: We demonstrate the case of a patient with a large tumor located in the right liver who underwent a total laparoscopic right hepatectomy. An anterior approach technique combined with Glissonian approach were used. The main steps of this technique are extraparenchymal control of right Glissonian pedicle en masse without liver dissection, parenchymal transection along the demarcation line, transection of right Glissonian pedicle, separation of whole right liver parenchyma, control and division of right hepatic vein and mobilization of the right liver from surrounding ligaments. No Pringle's maneuver was used.

Results: The technique was successfully performed without complication. Operative time was 560 min. Intraoperative blood loss was 1.100mL. The length of hospital stay was 6 days. The pathological report was well-differentiated HCC and free surgical margin.

Conclusion: Total laparoscopic right hepatectomy for large hepatoma by using the Glissonian pedicle control with anterior approach is feasible and safe.
Laparoscopic right hepatectomy for colorectal liver metastases
Major anatomical liver resections, initially considered to be unsuitable for laparoscopy, are increasingly reported by several centers worldwide. It is widely accepted that standards of open liver surgery should not be compromised during laparoscopic interventions. The video describes a totally laparoscopic right hepatectomy in an adipose patient (BMI of 44) for metastases of a rectal carcinoma.
24 months after sphincter-preserving radical rectal resection with TME (ypT3, ypN 0 (0/20), M0), metastases of the right liver were diagnosed during routine follow-up. According to MRI, endoscopy and PET-scan, metastases were limited to the right liver.
The procedure includes the following steps: positioning of the adipose patient, intermittent pneumatic calf compression for prevention of deep vein thrombosis, trocar placement, explorative laparoscopy, intraoperative diagnostic ultrasound, cholecystectomy, mobilization of the right liver, preparation of the hepatoduodenal ligament without Pringle’s maneuver, dissection and ligation of the right hepatic artery, right portal branch, and right hepatic duct, parenchymal dissection with ultrasonic surgical aspirator, a bipolar vessel-sealing device, vascular stapler only for larger vessels, ligation of right hepatic vein, sealing of the resection surface with bipolar coagulation, Argon beamer and fibrin glue, extraction of the resected specimen.
During surgery, the central venous pressure was kept low, no blood transfusions were performed and the postoperative course was uneventful. The pathological findings confirmed metastases of an adenocarcinoma with a maximal diameter of 6cm and clear resection margins. The patient was discharged 8 days after resection.
Laparoscopic right hepatectomy was carried out without compromising surgical principles established for open surgery. It is demonstrated that laparoscopic equipment such as intraoperative ultrasound, ultrasonic surgical aspirator, bipolar and Argon beamer coagulation and fibrin glue sealing can be used to their fullest extent. However, proficiency in both open liver surgery and advanced laparoscopy is compulsory.
M Schön
Surgical intervention
9 years ago
8763 views
31 likes
0 comments
16:10
Laparoscopic right hepatectomy for colorectal liver metastases
Major anatomical liver resections, initially considered to be unsuitable for laparoscopy, are increasingly reported by several centers worldwide. It is widely accepted that standards of open liver surgery should not be compromised during laparoscopic interventions. The video describes a totally laparoscopic right hepatectomy in an adipose patient (BMI of 44) for metastases of a rectal carcinoma.
24 months after sphincter-preserving radical rectal resection with TME (ypT3, ypN 0 (0/20), M0), metastases of the right liver were diagnosed during routine follow-up. According to MRI, endoscopy and PET-scan, metastases were limited to the right liver.
The procedure includes the following steps: positioning of the adipose patient, intermittent pneumatic calf compression for prevention of deep vein thrombosis, trocar placement, explorative laparoscopy, intraoperative diagnostic ultrasound, cholecystectomy, mobilization of the right liver, preparation of the hepatoduodenal ligament without Pringle’s maneuver, dissection and ligation of the right hepatic artery, right portal branch, and right hepatic duct, parenchymal dissection with ultrasonic surgical aspirator, a bipolar vessel-sealing device, vascular stapler only for larger vessels, ligation of right hepatic vein, sealing of the resection surface with bipolar coagulation, Argon beamer and fibrin glue, extraction of the resected specimen.
During surgery, the central venous pressure was kept low, no blood transfusions were performed and the postoperative course was uneventful. The pathological findings confirmed metastases of an adenocarcinoma with a maximal diameter of 6cm and clear resection margins. The patient was discharged 8 days after resection.
Laparoscopic right hepatectomy was carried out without compromising surgical principles established for open surgery. It is demonstrated that laparoscopic equipment such as intraoperative ultrasound, ultrasonic surgical aspirator, bipolar and Argon beamer coagulation and fibrin glue sealing can be used to their fullest extent. However, proficiency in both open liver surgery and advanced laparoscopy is compulsory.
Laparoscopic right hepatectomy: intra-hepatic Glissonian approach
This video demonstrates a totally laparoscopic approach to right hemi-hepatectomy. The right portal pedicle is first divided with an endoscopic stapler. The liver parenchyma is then divided with a combination of ultrasonic scalpel, Cavitron Ultrasound Surgical Aspirator (CUSA), bipolar cautery and clips.

Many surgeons prefer to employ the hand-assisted approach, but in this totally laparoscopic demonstration the author uses the intrahepatic Glissonian approach without the Pringle maneuver. The procedure starts with surgical exploration and laparoscopic evaluation of the liver. The harmonic scalpel divides the hepatic round and falciform ligaments. The author visualizes the suprahepatic inferior vena cava and right hepatic vein, then explores the hepatoduodenal ligament for enlarged lymph nodes. He then mobilizes the right liver as high as possible by transecting the right triangular ligament. Paying attention to the area of the adrenal gland, he dissects the gallbladder hilum, and transects both the cystic artery and duct. He starts the hepatic hilar dissection with an incision of the liver parenchyma, continuing outside the portal pedicle bifurcation toward the right and left sheet. The procedure continues with transection of the right portal pedicle.
B Topal
Surgical intervention
12 years ago
989 views
39 likes
0 comments
05:54
Laparoscopic right hepatectomy: intra-hepatic Glissonian approach
This video demonstrates a totally laparoscopic approach to right hemi-hepatectomy. The right portal pedicle is first divided with an endoscopic stapler. The liver parenchyma is then divided with a combination of ultrasonic scalpel, Cavitron Ultrasound Surgical Aspirator (CUSA), bipolar cautery and clips.

Many surgeons prefer to employ the hand-assisted approach, but in this totally laparoscopic demonstration the author uses the intrahepatic Glissonian approach without the Pringle maneuver. The procedure starts with surgical exploration and laparoscopic evaluation of the liver. The harmonic scalpel divides the hepatic round and falciform ligaments. The author visualizes the suprahepatic inferior vena cava and right hepatic vein, then explores the hepatoduodenal ligament for enlarged lymph nodes. He then mobilizes the right liver as high as possible by transecting the right triangular ligament. Paying attention to the area of the adrenal gland, he dissects the gallbladder hilum, and transects both the cystic artery and duct. He starts the hepatic hilar dissection with an incision of the liver parenchyma, continuing outside the portal pedicle bifurcation toward the right and left sheet. The procedure continues with transection of the right portal pedicle.
Laparoscopic treatment of a hydatid cyst of the liver
This video demonstrates the surgical approach to a large hydatid cyst in the right lobe of the liver. The surgeon uses a 3D reconstruction of the liver and the cyst to create a virtual image of the diseased area and to preplan the surgical approach. The surgeon starts by performing a cholecystectomy to gain better approach to the liver cyst. Then the cyst is aspirated and hypertonic saline is inserted for twenty minutes. Through a small opening in the cyst wall the contents are aspirated. Repeat instillation of hypertonic saline helps aspirate the contents. Once completed the cyst wall is opened wider and the cavity is fully inspected. The cyst is deroofed and the anterior cyst wall removed. The edges of the liver is covered with fibrin glue and a piece of omentum is brought up and sutured to it. A drain is left in place.
J Leroy
Surgical intervention
15 years ago
4152 views
38 likes
0 comments
01:54
Laparoscopic treatment of a hydatid cyst of the liver
This video demonstrates the surgical approach to a large hydatid cyst in the right lobe of the liver. The surgeon uses a 3D reconstruction of the liver and the cyst to create a virtual image of the diseased area and to preplan the surgical approach. The surgeon starts by performing a cholecystectomy to gain better approach to the liver cyst. Then the cyst is aspirated and hypertonic saline is inserted for twenty minutes. Through a small opening in the cyst wall the contents are aspirated. Repeat instillation of hypertonic saline helps aspirate the contents. Once completed the cyst wall is opened wider and the cavity is fully inspected. The cyst is deroofed and the anterior cyst wall removed. The edges of the liver is covered with fibrin glue and a piece of omentum is brought up and sutured to it. A drain is left in place.