Hand-assisted laparoscopic left lateral segmentectomy of the liver for hepatocellular carcinoma with cirrhosis

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Abstract
Background/Purpose. Despite recent progress in trials with laparoscopic hepatectomy, it is still necessary to develop safe and stable techniques. We have performed laparoscopic hepatic resection for 30 patients with liver tumors to date. We have recently been applying a hand-assisted laparoscopic surgical technique for greater safety. Methods. In the present study, we report techniques using a hand-assisted laparoscopic anatomical left-lateral segmentectomy for hepatocellular carcinoma with liver cirrhosis. Results. Direct feeling with the surgeon’s hand makes possible a procedure that is almost identical to open surgery in which there is better visualization of the surgical field and transected margin, and immediate hemostasis is also achieved by manually depressing the bleeding point. Conclusions. With this method, laparoscopic anatomical hepatectomy can be performed more safely for patients with cirrhosis than by the fully laparoscopic method, although a larger incision is necessary.

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