Hepatectomia Central Laparoscópica – Mesohepatectomia

Cirurgia de Figado – Hepatectomia Central Laparoscópica – Mesohepatectomia

Dr Marcel Autran Cesar Machado, Professor Livre-docente de Cirurgia da USP, publica video com narração em inglês do uso da laparoscopia no tratamento das metástases hepáticas em região central do fígado. Trata-se de cirurgia de figado – mesohepatectomia, totalmente por videolaparocopia. A intervenção cirúrgica consistiu na retirada dos segmentos 4, 5 e 8 do fígado utilizando o acesso intra-hepática aos pedículos glissonianos. Esta operação é também denominada de hepatectomia central.

Palavras-chave: Cirurgia de figado. Hepatectomia central. Mesohepatectomia. Metastase hepática. Metástases hepáticas de origem colorretal. Videolaparoscopia. Câncer do fígado.

Glissonian approach for laparoscopic mesohepatectomy

Machado MA, Kalil AN.
Surg Endosc. 2010 Dec 7. [Epub ahead of print]

Clique no vídeo abaixo para abrir filme editado (com narração em inglês)

BACKGROUND: Experience with advanced techniques has increased the indications for laparoscopic liver resection. This video demonstrates technical aspects of a pure laparoscopic mesohepatectomy using intrahepatic Glissonian technique. To the best of our knowledge, this is the first case of anatomic laparoscopic mesohepatectomy using the Glissonian approach published in the English literature.

METHODS: A 62-year-old man with colorectal liver metastasis occupying central liver segments was referred for surgical treatment. The first step is the control of segment 4 pedicle. Using the round ligament as a guide, one incision is performed on its right margin and another is made at the bottom of segment 4. A vascular clamp is introduced through those incisions to occlude segment 4 Glissonian sheath. The next step is to control the right anterior pedicle. The first incision is made in front of the hilum and another is performed on the right edge of gallbladder bed. Laparoscopic clamp is introduced through these incisions and closed producing ischemic discoloration of segments 5 and 8. Vascular clamp is replaced by an endoscopic vascular stapling device and stapler is fired. Line of liver transection is marked along the liver surface following ischemic area. Liver transection is accomplished with bipolar vessel sealing device and endoscopic stapling device as appropriate. Specimen was extracted through a suprapubic incision. Liver raw surfaces were reviewed for bleeding and bile leaks.

RESULTS: Operative time was 200 min with minimum blood loss and no need for blood transfusion. Recovery was uneventful, and the patient was discharged on the fifth postoperative day. Histological examination revealed clear surgical margins.

CONCLUSIONS: Mesohepatectomy can be safely performed laparoscopically in selected patients and by surgeons with expertise in both liver surgery and laparoscopic techniques. The use of the intrahepatic Glissonian approach may help to identify the exact limits of the mesohepatectomy to avoid ischemic injury of the remnant liver.

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