Totally Laparoscopic Resection of an Extremely Giant Hepatic Hemangioma

Abstract

Risk of massive intraoperative hemorrhage and the difficulty to control it makes the laparoscopic treatment of giant hepatic hemangiomas (GH) a challenge for minimally invasive hepatobiliary surgeons. Symptomatic GHs of more than 20 cm (extremely giant hepatic hemangiomas) are typically treated with an open resection. There is a paucity of literature on laparoscopic resection of extremely giant hepatic hemangiomas. We describe (with video), here, the technical nuances of pure laparoscopic resection of an extremely giant hepatic hemangioma using modified port positions and the anterior approach.

Keywords

liver hemangioma - laparoscopic liver resection - laparoscopic anterior approach - preoperative embolization - anatomical liver resection - pure laparoscopic hepatectomy

• References

• 1 Buell JF, Cherqui D, Geller DA. , et al; World Consensus Conference on Laparoscopic Surgery. The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann Surg 2009; 250 (05) 825-830
• 2 Liu X, Yang Z, Tan H. , et al. Characteristics and operative treatment of extremely giant liver hemangioma > 20 cm. Surgery 2017; 161 (06) 1514-1524
• 3 Jiang H, Chen Z, Prasoon P, Wu H, Zeng Y. Surgical management for giant liver hemangiomas greater than 20 cm in size. Gut Liver 2011; 5 (02) 228-233
• 4 Lanthaler M, Freund M, Nehoda H. Laparoscopic resection of a giant liver hemangioma. J Laparoendosc Adv Surg Tech A 2005; 15 (06) 624-626
• 5 Kim IS, Kwon CHD. Feasibility of laparoscopic liver resection for giant hemangioma of greater than 6 cm in diameter. Korean J Hepatobiliary Pancreat Surg 2014; 18 (04) 118-121
• 6 Zhang W, Wang J, Li C. , et al. Infrahepatic inferior vena cava clamping with Pringle maneuvers for laparoscopic extracapsular enucleation of giant liver hemangiomas. Surg Endosc 2017; 31 (09) 3628-3636
• 7 Liu C-L, Fan S-T, Lo C-M, Tung-Ping Poon R, Wong J. Anterior approach for major right hepatic resection for large hepatocellular carcinoma. Ann Surg 2000; 232 (01) 25-31