Name: Laparoscopic Left Liver Sectoriectomy of Carolis Disease Limited to Segment II and III (Video) | JoVE Journal
Uploaded: 2009-02-27T00:00:00.000+00:00
Duration: 4 min 41 s
Description: Learn laparoscopic left liver sectoriectomy for Caroli's disease affecting segments II and III. This surgical technique demonstrates minimally invasive treatment for bile duct dilation with reduced recovery time.

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5 minutes

Preoperative Workout
<ol>
<li>In the abdominal CT scan it can be easily seen the bile ducts (appearing inside the liver parenchyma with a darker color) widely enlarged on the left side of the liver .3D reconstruction demonstrated the presence of a right hepatic artery originating directly from the aorta and no further vascular abnormalities.</li>
<li>The liver can be functionally divided into 8 segments as shown in the video and considering that the dilatation was limited to segment 2 and 3 (left sectors), and a laparoscopic left sectoriectomy was planned.</li>
</ol>
Intraoperative procedure
<ol>
<li>The patient is placed in supine position and the surgeon stand between patient&rsquo;s legs. 5 trocars are used and placed as shown in the video</li>
<li>Vascular clamp is placed on the portal triad in order to reduce bleeding (Pringle&rsquo;s manouvre)</li>
<li>Division of the liver parenchyma is performed using a combination or bipolar electrocautery and harmonic scalpel along the falciform ligament between segment III and IV</li>
<li>Once the segment III pedicle is fully dissected it can be divided using a 45mm endo GIA with a vascular cartridge.</li>
<li>he procedure carries on with further division of the parenchyma till the main pedicle to segment II is reached, isolated and finally divided using a 45mm endoGIA with vascular cartridge</li>
<li>The left triangular ligament is now divided using electrocautery and the left hepatic vein is isolated and divided using vascular stapler</li>
<li>The liver surface is checked for bleeding; argon beam is applied on the liver surface and the vascular clamp is removed. At this point fibrin glue is applied on order to reduce the risk of post-operative bile leaks. The specimen is placed in endobag and removed</li>
</ol>

<ol><li>Nguyen, K. T., Gamblin, T. C., Geller, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laparoscopic+liver+resection+for+cancer%5BTitle%5D)+AND+%22Future+Oncol%22%5BJournal%5D)">Laparoscopic liver resection for cancer.</a> Future Oncol. 4 (5), 661-670 (2008).</li>
<li>Gumbs, A. A., Gayet, B., Gagner, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laparoscopic+liver+resection%3A+when+to+use+the+laparoscopic+stapler+device%5BTitle%5D)+AND+%22HPB+%28Oxford%29%22%5BJournal%5D)">Laparoscopic liver resection: when to use the laparoscopic stapler device.</a> HPB (Oxford). 10 (4), 296-303 (2008).</li>
<li>Pulitanò, C., Catena, M., Arru, M., Guzzetti, E., Comotti, L., Ferla, G., Aldrighetti, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Laparoscopic+liver+resection+without+portal+clamping%3A+a+prospective+evaluation%5BTitle%5D)+AND+%22Surg+Endosc%22%5BJournal%5D)">Laparoscopic liver resection without portal clamping: a prospective evaluation.</a> Surg Endosc. 22 (10), 2196-2200 (2008).</li>
<li>Yonem, O., Bayraktar, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Clinical+characteristics+of+Caroli%27s+disease%5BTitle%5D)+AND+%22World+J+Gastroenterol%22%5BJournal%5D)">Clinical characteristics of Caroli's disease.</a> World J Gastroenterol. 13 (13), 1934-1937 (2007).</li>
</ol>

Laparoscopic surgery can be safely performed also for liver resection both for benign and malignant diseases. Reducing surgical trauma using minimally invasive approach allows to minimize the incidence of post-operative complications and post-operative hospital stay.

laparoscopic left liver sectoriectomy of caroli's disease limited to segment ii and iii

Laparoscopic Left Liver Sectoriectomy of Caroli's Disease Limited to Segment II and III

Caroli's disease is defined as a abnormal dilatation of the intra-hepatica bile ducts: Its incidence is extremely low (1 in 1,000,000 population) and in most of the cases the whole liver is interested and liver transplantation is the treatment of choice. In case of dilatation limited to the left or right lobe, liver resection can be performed. For many year the standard approach for liver resection has been a formal laparotomy by means of a large incision of abdomen that is characterized by significant post-operatie morbidity. More recently, minimally invasive, laparoscopic approach has been proposed as possible surgical technique for liver resection both for benign and malignant diseases. The main benefits of the minimally invasive approach is represented by a significant reduction of the surgical trauma that allows a faster recovery a less post-operative complications.
This video shows a case of Caroli s disease occured in a 58 years old male admitted at the gastroenterology department for sudden onset of abdominal pain associated with fever (>38C&deg; ), nausea and shivering. Abdominal ultrasound demonstrated a significant dilatation of intra-hepatic left sited bile ducts with no evidences of gallbladder or common bile duct stones. Such findings were confirmed abdominal high resolution computer tomography. 
Laparoscopic left sectoriectomy was planned. Five trocars and 30&deg; optic was used, exploration of the abdominal cavity showed no adhesions or evidences of other diseases.
In order to control blood inflow to the liver, vascular clamp was placed on the hepatic pedicle (Pringle s manouvre), Parenchymal division is carried out with a combined use of 5 mm bipolar forceps and 5 mm ultrasonic dissector. A severely dilated left hepatic duct was isolated and divided using a 45mm endoscopic vascular stapler. Liver dissection was continued up to isolation of the main left portal branch that was then divided with a further cartridge of 45 mm vascular stapler.
At his point the left liver remains attached only by the left hepatic vein: division of the triangular ligament was performed using monopolar hook and the hepatic vein isolated and the divided using vascular stapler.
Haemostatis was refined by application of argon beam coagulation and no bleeding was revealed even after removal of the vascular clamp (total Pringle s time 27 minutes).
Postoperative course was uneventful, minimal elevation of the liver function tests was recorded in post-operative day 1 but returned to normal at discharged on post-operative day 3.

This video presents a case of laparoscopic left liver sectoriectomy perfomed in a 53 year old man suffering from Caroli's disease limited to segment II and III of the liver.

Caroli's disease is defined as a abnormal dilatation of the intra-hepatica bile ducts: Its  incidence is extremely low  (1 in 1,000,000 population) and in ...

This video shows a case of laparoscopic left ectomy for Carly disease limited to segment two and three of the liver. A 53-year-old male patient was admitted to the hospital for recurrent right-sided abdominal pain associated with fever. Abdominal CT scan demonstrated a segmented dilatation of the repath ducts limited to those segment two and three of the liver as in left sided cly disease.3D.Reconstruction of the eria blood flow demonstrated the presence of the RightPath artery of originating directive from the orta. While no abnormalities were revealed in the portal system, A laparoscopic Left ectomy was then implanted. Patient was placed in supine position.The operating surgeon stands between patient legs and five toker have used. The position of the toker can be seen in this scheme. The procedure starts with Exploration of the abdominal cavity and after the placement of the remaining four toker, a laparoscopic vascular clamp is placed on the liver ilum in order to reduce the bleeding during division of the liver parenchyma.We currently do not use this sort of ingal maneuver anymore, although a tape is always placed around the ilum and tight neck In case of bleeding. The division of the liver parenchyma is performed using a combination of bipolar electro cordery and monic scalpel along the falciform ligament between segment three and four. This maneuver allows to expose the segment three main pedicle.When the segment three pedicle is fully dissected, it can be divided using a 45 millimeter in the GIA with a vascular cartridge. The procedure Carries on with further division of the parenchyma till the main P hole to segment two is reached, isolated, and then finally divided using a further cartridge of 45 millimeter in the GIA At this point, The left lower of the liver is attached to the remaining parenchyma only by the left, so particle vein and the left triangle or ligament who is now divided using a later Tery using an in partic approach. The left partic vein is isolated and then divided Using a vascular staple due to the deep location Of the vein.More than one cartridge is usually required at this point. The left ectomy is completed. The liver of phase is checked for bleeding and argon beam is applied on the levels of face.The vascular clump is Then removed at this point. Fing glue is applied in order to reduce the risk of postoperative bio leaks. Specimen is placed into an endo bag and remove alar one of the axis.A 24 French silicone drain is left in place for 48 hours. The patient is usually discharged on postoperative day three.

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Learn laparoscopic left liver sectoriectomy for Caroli's disease affecting segments II and III. This surgical technique demonstrates minimally invasive treatment for bile duct dilation with reduced recovery time.

Laparoscopic Left Liver Sectoriectomy of Caroli's Disease Limited to Segment II and III

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