LAPAROSCOPIC RESECTION OF A 5 CM HEPATOCELLULAR CARCINOMA IN THE SEGMENT VII IN A CIRRHOTIC LIVER WITH PORTAL HYPERTENSION USING THE HABIBTM 4X DEVICE
EAES Online Library. Poves Prim I. Jan 10, 2012; 19879
Dr. Ignasi Poves Prim
Dr. Ignasi Poves Prim
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Abstract
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Introduction: Surgical resection is the preferred curative option for the treatment of the hepatocelullar carcinoma (HCC) when hepatic transplantation is not possible. Radiofrequency (RF) ablation is a good alternative for small HCC less than 2 cm located deep into the liver. Hepatic resection in cirrhotic patients is associated with high rates of morbidity and mortality. Although laparoscopic approach is gaining popularity, there is a risk of major bleeding during hepatectomy in cirrhotic patients. A new bipolar RF device (HabibTM 4X, Generator 1500X, RITA Medical Systems, Inc. California, USA) has been developed to assist liver resection laparoscopically. It produces controlled RF energy between the electrodes sealing major biliary and blood vessels. Liver parenchyma can be spared with less blood loss and biliary leak. Video presentation: A 70 years-old woman diagnosed of hepatitis C virus cirrhosis was diagnosed of a 5.5 cm HCC located in the segment VII. She had a functional grade A (5 points) score in the Child-Pugh classification. Portal hypertension was documented by oesophageal grade II varices and 44.000 serum platelets. In a multidisciplinary committee it was decided to perform a hepatic resection. It was used the laparoscopic HabibTM 4X device and LigasureTM V (Covidien). All the procedure was done without hiliar clamping. Cholecistectomy was done because of cholelithiasis. The specimen was removed through an enlargement of a recurrent umbilical hernia. Operative blood lost was near 600 ml. Total operative time was 244 minutes (155 minutes for the hepatectomy). In the early postoperative course the patient was reoperated due to persistent bleeding through an abdominal drain. A re-laparoscopy was done finding a slow, but persistent bleeding in the retroperitoneal fat around the hepatic flexure of the colon. No bleeding was found in the hepatic section line. The patient had a posterior normal recovery and was discharged on 7th day. Final diagnosis was of 55 mm HCC with free margins of 10 mm. Conclusions: Laparoscopic HabibTM 4X is a very useful device for achieving optimal hemostasis during laparoscopic hepatectomy, specially in those patients with macronodular cirrhosis and portal hypertension.
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