Laparoscopic Liver Surgery

FIGURE 20.1 Trocar placement for left lateral sectionectomy.

Laparoscopic Right Hepatectomy. We follow the same technique as the open approach. The advantages of laparoscopy are better visualization, especially of the areas behind the liver, over the inferior vena cava (IVC), over the right hepatic vein, etc. Also, the increased pressure of the pneumoperitoneum keeps the operative field relatively bloodless as small venules on the transection line are collapsed. Since the patient will need an incision for specimen extraction, a hand-assisted technique has been developed with an additional advantage for liver mobilization, compression, and urgent management of major vascular bleeding. We place the trocars as shown in Figure 20.2

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