Left Lateral Sectionectomy Performed Under Minimal Open Access after the Completion of Hand-Assisted Laparoscopic Mobilization

Purpose: Left lateral sectionectomy is one of the best methods for laparoscopic anatomical liver resection. We have developed a three-port method for anatomical left lateral sectionectomy, in which the sectionectomy is performed via a minimal incision after hand-assisted laparoscopic mobilization. Methods: Access for the open laparotomy was obtained by making an 8 cm incision for a hand port. The other ports were used as the camera port and working port. Liver immobilization was completed under pneumoperitoneum. Fingertip tape ligation is a very simple method for encircling the hepatoduodenal ligament and does not require any special equipment. The standard open technique was then employed for liver dissection through the minilaparotomy. We compared the clinical and operative variables of the patients that underwent the open procedure (n = 6) with those of the patients that underwent the laparoscopic procedure (n = 5) at our institute between January 2005 through June 2008. Results: We developed a three-port method for left lateral sectionectomy. No technical difficulties or major complications occurred. The laparoscopy group exhibited significantly less intraoperative bleeding and a significantly shorter period of hospitalization than the open procedure group. Conclusion: The three-port method is suitable for hand-assisted left lateral sectionectomy and is easily repeatable by all liver surgeons, as it does not require any special skills.