Laparoscopic Right Hemihepatic Vascular Inflow Occlusion by Lowering of the Hilar Plate

Introduction: Laparoscopic liver resection under hemihepatic vascular inflow occlusion has advantages over the conventional Pringle's maneuver, especially in patients with cirrhosis. However, laparoscopic hemihepatic vascular inflow occlusion is technically challenging. Subjects and Methods: From March 2013 to August 2013, 8 consecutive patients who underwent laparoscopic liver resection under right hemivascular inflow occlusion using the lowering of the hilar plate approach. Results: There were 3 women and 5 men, with a mean age of 52.6 years (range, 44-73 years). The pathologies were hepatocellular carcinoma (n=3), sarcomatoid liver carcinoma (n=1), hepatic vascular epithelial tumor (n=1), hemangioma (n=2), and colorectal liver metastases (n=1). The types of resection included right hepatectomy (n=3), right anterior sectionectomy (n=1), segments 5 and 6 resection (n=1), and segment 6 resection (n=2). All patients underwent right hemivascular inflow occlusion. The mean operation time was 186.2 minutes (range, 100-280 minutes). The mean time taken to prepare for hemivascular inflow occlusion was 17.8 minutes (range, 15-20 minutes). The mean intraoperative blood loss was 218.8 mL (range, 100-300 mL). The mean duration of vascular control was 25.6 minutes (range, 15-40 minutes). No patients developed postoperative liver failure. There was no postoperative morbidity or mortality. The mean hospital stay was 6 days (range, 5-7 days). Conclusions: Hemihepatic vascular inflow occlusion using the lowering of the hilar plate approach was safe and feasible. It facilitated laparoscopic liver resection by minimizing blood loss during liver parenchymal transection.