LAPAROSCOPIC LEFT LATERAL SECTIONECTOMY AT DR GEORGE MUKHARI ACADEMIC HOSPITAL.

Govender, M; Matsevych, O Y

BACKGROUND Laparoscopic left lateral sectionectomy has rapidly become a standard of care for patients requiring excision of segments 2 and 3. We present our technique of the resection. METHOD Videos of patients having had left lateral sectionectomies were reviewed. Patients were placed in supine with reverse Trendelenburg position. Three ports were used: one 12 mm at the umbilicus for the camera, one 12 mm placed 5 cm above and to the right of the umbilicus and one 5 mm port to the left. A Ligasure® 5 mm (Covidien®) was used to take down the falciform ligament initially staying close to the abdominal wall and then stopping at the bifurcation of the two layers of peritoneum. The triangular ligament was incised to create a window between diaphragm and liver. Unlike open surgery the entire ligament was not mobilised at this stage. A line was scored on the left of the falciform ligament. Transection of the parenchyma was achieved with Ligasure®. Once the liver parenchyma was thinned, an endostapler - EndoGIA® Gold (Covidien®) - was be used to complete the transection. It was also possible to dissect out individual vessels and ligate with Hem-o-lok® (Teleflex®) clips in one case. The cut surface was examined for bleeding or bile leaks. A small pencil drain was placed. RESULTS Three patients had laparoscopic resections. All were female. Two cases were haemangioma with one diagnosed preoperatively and the other not having typical features on imaging. The third case was a large adenoma in a patient with hepatic adenomatosis. No bile leaks were noted. No patient required blood transfusion. Average length of stay was 1 day. CONCLUSION Laparoscopic left lateral sectionectomy is a stepping stone to more complex laparoscopic liver resections. It is feasible and safe in a tertiary institute in South Africa.