Laparoscopic Wedge Resection of the Liver

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • Laparoscopic liver biopsy:
    • Same as for percutaneous liver biopsy
    • Staging of malignancy
    • Ascites of unclear etiology
    • Peritoneal infections
    • Evaluation of abdominal mass
    • Chronic abdominal pain
    • Unexplained hepatosplenomegaly
  • Wedge resection:
    • Solitary small metastatic lesion
    • Symptomatic small hemangioma or focal nodular hyperplasia
    • Hepatic adenomas
    • Small symptomatic simple or complex cysts
    • All lesions suspicious for hepatocellular carcinoma that are smaller than 2 cm
CONTRAINDICATIONS
  • Poor cardiorespiratory function
  • Inability to tolerate general anesthesia
  • Hemodynamic instability
  • Intestinal obstruction
  • Bacterial peritonitis
  • Uncooperative patient (relative)
  • Severe coagulopathy (relative)
  • Morbid obesity (relative)
  • Large ventral hernia (relative)
  • Cirrhotic liver
  • Previous open hepatectomy (relative)
EQUIPMENT
  • Anesthetic unit
  • Operating table
  • Standard laparoscopic instrument table
  • Specialized laparoscopic instrument table
  • Instruments used for standard open hepatic resections
  • Laparoscopic unit: 30- or 45-degree laparoscope
  • Two monitors
ANATOMY
  • The left hepatic vein demarcates an anterior sector (segments III and IV) and a posterior sector (segment II). The right hepatic vein delineates two right lobe sectors: right posterolateral sector (segments VI and VII) and an anteromedial sector (segments V and VIII).
  • In general, segments II, III, IV, V, and VI are the most suitable for a laparoscopic approach to solid or cystic lesions.

PROCEDURE
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The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • IV fluids
  • Clear liquid diet and advance as tolerated to regular diet
  • Ambulation on postoperative day 1
  • Subcutaneous unfractionated heparin or low molecular weight heparin for deep venous thrombosis prophylaxis until patients are ambulating without assistance
  • Complete blood cell counts and chemistries, including phosphorus levels, checked daily
COMPLICATIONS
  • Respiratory complications
  • Hemorrhage from biopsy/wedge site
  • Abdominal viscus perforation
  • Hemobilia
  • Ascites and liver failure
  • Bile leak
  • Abscess
  • Abdominal wall hematoma
  • Common to all laparoscopic procedures: CO2 embolism, trocar site bleeding, hernia
RESULT ANALYSIS
  • Laparoscopic liver biopsy is likely to have a higher diagnostic yield in patients with cirrhosis compared with percutaneous liver biopsy and is excellent for staging the extent of disease in patients with various intra-abdominal malignancies.
  • Minimally invasive wedge resection is particularly useful in cases of metastases, because the laparoscopic approach results in fewer adhesions and reoperation is much easier in these patients who may require it.
  • Benefits to the patient include decreased hospital stay, analgesic requirements, and time to ambulation.
  • Disadvantages include a loss of palpation and the three-dimensional spatial localization of the tumors in relation to the hepatic structures.
  • The surgeon's skill level with both laparoscopy and liver surgery is a critical element for the safe and effective practice of minimally invasive liver surgery.
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