Retrieval of liver specimen in laparoscopic hepatectomy

A series of experimental and clinical laparoscopic hepatectomies has been performed. An experimental left lateral lobectomy of the liver of a pig was performed safely in four cases. The five clinical cases involved two metastatic liver tumours, one hepatocellular carcinoma, one haemangioma and one case of Wilson's disease. The operative methods used were left lateral segmentectomy in two cases, and partial hepatectomy of the left lobe in three cases. The four cases were performed safely although one left lateral segmentectomy unfortunately required open laparotomy due to haemorrhage. It was necessary to insert five trocars for operative manipulation in most cases. After insertion of trocars, we changed to abdominal wall lifting without pneumoperitoneum. For parenchymal division, ultrasonic surgical dissection was used in combination with a microwave tissue coagulator. The branched vessels and ducts in the liver were transected after clipping. Haemostasis of the transection plane was secured by using an argon beam coagulator and fibrin starch. Laparoscopic hepatectomy is accordingly considered to be a feasible operation applicable in selected patients.