Hepatic parenchymal transection in laparoscopic hepatectomy for hepatocellular carcinoma with liver cirrhosis —Selection and technique of surgical devices

Abstract

Clinical application of laparoscopic hepatectomy for hepatocellular carcinoma depends on the development of surgical devices, especially in cirrhotic liver. However, there is no device suitable for all the situations as coagulation, skeltonization and division in liver transection. We have been introducing TissueLink monopolar sealer (TMS)/DS 3.0 which can provide excellent hemostasis in parenchymal transection through the small incision in laparoscope assisted left lateral segmentectomy. Partial hepatectomy for tumor located in the edge of lower segment can be performed using only TMS/endo (SH2.0) sealing hook. In tumorectomy located in the ventral surface of liver, the use of microwave tissue coagulator and laparoscopic coagulating shears is appropriate combination to obtain safe surgical margin and hemostasis. Important considerations for successful laparoscopic hepatectomy are the selection and the surgical skill of appropriate devices as well as the patient selection.