Clinical role of laparoscopic hepatectomy using vessel sealer and soft coagulation for small hepatic tumors suspected of malignancy.

BACKGROUNDS/AIMS: Laparoscopic hepatectomy may provid a less invasive treatment and diagnostic modality. To date, however, few reports have been published on a clinical usefulness of laproscopic hepatectomy using vessel sealer (VS) and soft-coagulation system (SC) for small hepatic tumors suspected of malignancy.

METHODOLOGY: Case 1; A 58-year-old man presented with a small hepatic tumor, detected during a medical examination. Image sutdies including ultrasonography, magnetic resonance image and angiography suspected it as hepatocellular carcinoma (HCC), adenoma, angiomyolipoma, or focal nodular hyperplasia (FNH). Laparoscopic hepatectomy was performed after enhanced ultrasonography. Histopathological diagnosis was FNH. Case 2; A 57-year-old man presented with a small hepatic tumor, detected during a medical examination. Image stuides suspected it as HCC or adenoma. Laparoscopic medial segmentectomy was performed. Histopathological diagnosis was HCC. Case 3; A 59-year old man with a history of early colon cancer presented with a small hepatic tumor, detected during a routine check-up. Image studies showed it, and laparoscopic lateral segmentectomy was performed. Histopathological diagnosis was adenocarcinoma. Using VS and SC, laparoscopic hepatectomy was performed safely without any morbidity. Glisson's trunk and the left hepatic vain were transected with endo-linear staplers.

DISCUSSIONS: It has been difficult to obtain a biopsy specimen from small lesions and make a denifite diagnosis even with the specimen. There are risks of dissemination and route recurrence. Recurrence rates have been reported to be relatively high after radio frequency ablation. Laparoscopic hepatectomy represents an intermediate option between ablation therapy and conventional hepatectomy.

CONCLUSIONS: Laparoscopic hepatectomy using VS and SC may be a less invasive and radical treatment as well as an useful diagnostic modality for small hepatic tumors suspected of malignancy.