Abstract
We performed combination hepatectomy three cases for multiple cancers in bilateral lobes of the liver. Combination hepatectomy were performed as follows: case 1; combination of pure laparoscopic hepatectomy and hepatectomy under thoracolaparotomy, case 2; combination of pure laparoscopic hepatectomy and hand-assisted laparoscopic hepatectomy and case 3; combination of laparoscopy-assisted hepatectomy and minimum invasive hepatectomy. Operation time and blood loss were 9 hours 10 minutes and 2,200 g in case 1, 5 hours 59 minutes and 250 g in case 2 and 8 hours 35minutes and 900 g in case 3, respectively. Post operative courses were uneventful and no complications were occurred. Discharge was allowed on postoperative day 14 in case 1, 5 in case 2 and 7 in case 3.
In case of multiple tumors in bilateral lobes of the liver, we should consider multiple approaches for each tumors including laparoscopic approach. If we could not resect all of the tumors by pure laparoscopic approach, we may choice the optimal approach from multiple approaches according to intraoperative findings. Our experiences indicated that combination hepatectomy contributed to achieve less invasive surgery for multiple liver tumors than ordinary hepatectomy under laparotomy.
