Objective To evaluate left liver anatomical resection via left vertical groove by laparoscope.Method Among 103 patients with left intrahepatic biliary calculi,39 cases underwent left lateral hepatectomy,20 cases did left liver anatomical resection via left vertical groove by laparoscope,29 cases underwent left lateral hepatectomy via left liver diaphragmatic surface,15 cases did left liver anatomical resection via the first porta.Result In the 103 cases of laparoscopic left liver anatomical resection,101 cases were successful and two cases were conversed to open surgery.In the success group,total laparoscopic anatomical left lateral lobectomy was performed (Ⅱ,Ⅲ section) in 68 cases.Compared with the approach via left liver falciform ligament diaphragmatic surface,the operatve time via left vertical groove was significantly shorter(t =-2.723,P =0.008,intraoperative blood loss was significantly smaller (t =-5.399,P =0.000),while the differences in postoperative hospital stay (t =-0.168,P =0.867) and postoperative complications (x2 =0.664,P =0.415) were of no statistical significance between the 2 groups.In the 33 cases of left hemihepatectomy (Ⅱ,Ⅲ,Ⅳ section),those performed via left vertical groove compared with through the first porta hepatic,used shorter operation time(t =-3.144,P =0.004),while blood loss was similar(t =-1.049,P =0.302),as well as the length of hospital stay(t =0.784,P =0.439).There was no postoperative bleeding and intractable bile leakage,nor postoperative air embolism.Flatus on an average of (2.5 ± 1.2) days.Patients were discharged from hospital 5-17 (9.98 ±2.98) days post-op.96 cases were followed up in the 101 cases undergoing successful total laparoscopic left hemihepatectomy.The followed-up time were 3-52 (32.6 ± 5.7) months.Postoperative review found no residue stone.One case in first porta hepatis group,caudate lobe atrophy was found by postoperative CT.Conclusions Left liver anatomical resection via left vertical groove by laparoscope is less traumatic,quick recovery with satisfactory clinical curative effect for the treatment of left hepatolithiasis.

Objective To study the feasibility and efficacy of intraoperative choledoscopy combined with laparoscopic left liver resection to treat intrahepatic lithiasis.Method In 49 patients with biliary stone,laparoscopic left lateral sectionectomy/left medial sectionectomy/left hepatectomy combined with intraoperative choledochoscopy and stone retrieval were carried out.Results Laparoscopic left lateral sectionectomy was carried out in 29 patients,left medial sectionectomy in 2 patients and left hepatectomy in 18 patients.In all the patients,combined choledoscopy and stone retrieval were carried out.A concomitant laparoscopic cholecystectomy (LC) was carried out in 11 patients.The average operative time was 226 min.When LC was carried out,the mean operative time was 243 min.The mean intraoperative blood loss was 378 ml.There was no bile leak or postoperative bleeding.Flatus was passed 1-3 days after surgery.The patients were discharged home 7-10 days after surgery.Postoperative MRI/MRCP did not reveal any residual stone.On a mean follow up of 16 months for 47 patients,the patients did well and there was no recurrent stone.Conclusion Choledochoscopy combined with laparoscopic left liver resection for bile duct stone resulted in minimal trauma to the patient.The recovery was quick and there was a high stone clearance rate.The treatment was safe,efficacious,and it is a viable minimally invasive treatment option.

Objective To evaluate laparoscopic right hepatectomy through the right incisura or the right groove for hepatic benign disease.Methods This study enrolled 32 patients of hepatic benign lesions within the right lobe of the liver including hepatic hemangioma (n =7),hepatic focal nodular hyperplasia (n =2),right intra-hepatic bile duct stones (n =23) with concomitant extra-hepatic bile duct stones in 19 cases.Results Laparoscopic procedures were successful in 28 patients,while 4 patients were converted to laparotomy.Time of operation was 235 to 405 min,time for right hemihepatectomy was (305 ±41) min on average.Time for right hemihepatectomy and biliary tract exploration and removal of stones was (326 ± 48)min on average.The intraoperative blood loss was (573 ±219) ml on average.On postoperative follow-up,patients with hepatic hemangioma and focal nodular hyperplasia had no residual lesions.2 cases suffered calculus residue,residual stones were removed by repeat choledochoscopy with primary stones clearence rate of 91.3％ (21/23).Bile leakage occurred in 3 cases and pleural effusion in 7 cases.The gastrointestinal function recovered (2.8 ± 0.71) days after surgery.The hospital stay was (11.5 ± 2.98) days.28 patients were followed up for (32 ± 8) months.Conclusion The laparoscopic anatomical right hemihepatectomy through the right incisura or the right groove is a satisfactory surgical procedure.