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Laparoscopic right posterior sectionectomy (LRPS): surgical techniques and clinical outcomes

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Abstract

Background

Right posterior sectionectomy is one of the most technically challenging laparoscopic liver resections. Currently, there is limited published data regarding the technique and results required to better understand its safety and feasibility.

Aim

To report our experience, results and techniques, highlighting a variety of tips and tricks to facilitate this resection. A video is attached for technical demonstration.

Methods

Retrospective review of prospectively maintained databases from June 2006 to June 2016. Three different techniques were used: resection following hilar inflow control, inflow control at Rouviere’s sulcus and resection with intra parenchymal control.

Results

29 LRPS were performed over a 10-year period. Median operative time was 240 min (150–480). Pringle’s manoeuvre was performed in 19 (65.5%) with a median total duration of 35 (20–75) min. Median perioperative blood loss was 600 (100–2500) ml. Additional liver resections were performed in 16 (55.1%). There were two(6.9%) laparoscopic to open conversions. Median postoperative hospital stay was 5 (2–30) days. The median size of the tumour resected was 25 (10–54) mm with median number of resected lesions were 2 (1–4), median free resection margin was 9.5 (1–45) mm, margins were infiltrated (R1) in two (6.7%) cases. There was one death within 30-days (3.4%).

Conclusion

LRPS is feasible, efficient and safe. However, it is a technically challenging procedure and requires advance skills in liver and laparoscopic surgery. Surgeons should be familiar with a variety of approaches as each offers different advantages depending on the location and nature of the lesion, surgical preference and intraoperative findings.

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Abbreviations

LRPS:

Laparoscopic right posterior sectionectomy

CRLM:

Colorectal liver metastasis

RPS:

Right posterior sectionectomy

HCC:

Hepatocellular carcinoma

NET:

Neuroendocrine tumour

IOUS:

Intraoperative ultrasound

RS:

Rouviere’s sulcus

RHA:

Right hepatic artery

RHV:

Right hepatic vein

RPA:

Right posterior artery

RPV:

Right posterior vein

IVC:

Inferior vena cava

CPAP:

Continuous positive pressure airway

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Authors and Affiliations

  1. Department of Hepato-Biliary and Pancreatic Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK

    Najaf N. Siddiqi, Mahmoud Abuawwad, Mark Halls, Arab Rawashdeh, Francesco Giovinazzo, Anas Aljaiuossi, Dennis Wicherts, Mathieu D’Hondt & Mohammed Abu Hilal

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  1. Najaf N. Siddiqi
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  2. Mahmoud Abuawwad
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Correspondence to Najaf N. Siddiqi.

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Najaf N. Siddiqi, Mahmoud Abuawwad, Mark Halls, Francesco Giovinazzo, Arab Rawashdeh, Anas Aljaiuossi, Dennis Wicherts, Mathieu D’Hondt, and Mohammed Abu Hilal have no conflicts of interest or financial ties to disclose.

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Siddiqi, N.N., Abuawwad, M., Halls, M. et al. Laparoscopic right posterior sectionectomy (LRPS): surgical techniques and clinical outcomes. Surg Endosc 32, 2525–2532 (2018). https://doi.org/10.1007/s00464-017-5958-2

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