shan Pure laparoscopic hepatectomy in semiprone po课件.pptVIP

Shan Baga Pure laparoscopic hepatectomy in semiprone position for righthepatic major resection Contents Abstract Pure laparoscopic liver resection is difficult for tumors located in the dorsal anterior and posterior sectors. We have developed a maneuver to perform pure laparoscopic hepatectomy in the semiprone position which was developed for resecting tumors located in these areas. Introduction We managed to perform pure laparoscopic partial hepatectomy for tumors located at the inferior edge of the liver and left lateral segmentectomy in a safe, stable manner. We found changing position is easy, feasible and resultful. Methods PATIENTS:A total of 30 laparoscopic hepatectomy procedures were performed in the semiprone position between February 2010 and November 2011. Methods semiprone position location and blocking cutting and sealing getting the specimen Pure laparoscopic hepatectomy in the semiprone position. Pneumoperitoneum was established at a pressure of 8 mmHg, and four trocars were inserted below the costal arch from the right middle axillary line to the midline. A 30° laparoscope and 5 and 12 mm trocars were used. With the patient in this position, complete resection consisted of the following three steps. First, Rouviere’s sulcus was identified, and the posteroinferior Glisson’s sheath, which runs behind Rouviere’s sulcus, was isolated. After division of a substantial amount of hepatic tissue along Glisson’s sheath, the hepatic pedicle structures were divided within the liver tissues.For selective inflow occlusion, the intrahepatic portion of the Glissonian pedicle toward the lesion or area to be removed was encircled with tape and clamped. Rouviere’s sulcus After the ischemic demarcation line had been clearly observed along the planned resection line, the clamped Glissonian pedicles were usually divided with Hem-o-lok clips. Second, sufficient amou