Laparoscopic Hepatectomy is Easier in Repeat Hepatectomy
Naruhiko Ikoma, MD, Osamu Itano, MD, PhD, Go Oshima, MD, Shinil K. Shah, MD, Shinichi Fukuhara, MD, Yuko Kitagawa, MD, PhD, FACS
Department of Surgery, University of Texas Medical School at Houston, Houston, Texas, USA (Drs. Ikoma and Shah); Keio University, School of Medicine, Tokyo, Japan (Drs. Ikoma, Itano, Oshima, and Kitagawa); Department of Surgery, Eiju General Hospital, Tokyo, Japan (Drs. Ikoma, Itano, and Oshima); Department of Surgery, Beth Israel Medical Center, New York, New York, USA (Dr. Fukuhara); Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, Texas, USA (Dr. Shah).
Hepatic malignancies are frequently associated with primary liver disease, including hepatitis and cirrhosis. It is not uncommon for selected patients to require repeated operations for tumor recurrence. Subsequent operations are more challenging because of dense adhesions from prior operations combined with the inherent risk for liver dysfunction. We present the case of a 64-year-old man with a 20-year history of hepatitis B who developed recurrent hepatocellular carcinoma and underwent repeated laparoscopic hepatectomies on 4 separate occasions. We found that the laparoscopic approach in repeat hepatectomy offers significant advantages, including minimal adhesions, superior visualization, and favorable effect by generated by pneumoperitoneum. Laparoscopic hepatectomy will potentially become a standard strategy for the treatment of liver malignancies associated with background liver abnormalities, which carry the high possibility of reemergence of the liver malignancy in the remnant of the liver.
Key Words: Laparoscopic surgery, Hepatectomy, HCC, Hepatitis.