Laparoscopic Liver Resection

Overview

Rapid development of liver surgery in the last 25 years results from introduction of new procedures entailing an increase in the number of operated patients, and simultaneously a reduction in risk of the surgery and subsequent postoperative morbidity and mortality. They include standard preoperative examination completed by new high-resolution diagnostic methods (duplex ultrasound, spiral CT, liver scintigraphy, PET) which can better reveal the pathological focus in relation to liver anatomy and largely contribute to the consideration of resecability of the liver affection [1]. Standard resection technique is, in addition to the advantage of an anatomical resection, completed with modern technology which helps to reduce the blood loss and ischemic damage to the remaining liver parenchyma especially in non-anatomical resections. Nowadays, liver resections are performed by a combination of various techniques. One of them is a liver parenchyma resection using a harmonic scalpel [2] in the classical surgical procedure. There are also mini-invasive laparoscopic operations, and recently robotic resections which can’t be done without the harmonic scalpel [3, 4].

The authors present a case report of a 25-year-old woman who developed spastic pain in the epigastrium three years ago. Sonography, CT, MR, liver scintigraphy and, last but not least, diagnostic laparoscopy were used for accurate diagnostics. Diagnostic laparoscopy was performed in order to confirm the diagnosis, extent of surgery and especially the possibility of performing laparoscopic liver resection. This was carried out using the harmonic scalpel which is the method of choice especially in non-anatomical resection for better control of bleeding and safer isolation of bile ducts and vessels.

Key words:
focal nodular hyperplasia – diagnostic laparoscopy – laparoscopic resection